Provider Demographics
NPI:1578833992
Name:DILLON, ROBERT GWYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GWYN
Last Name:DILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3341 FOXFORD CT
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4442
Mailing Address - Country:US
Mailing Address - Phone:770-939-6671
Mailing Address - Fax:770-939-6671
Practice Address - Street 1:3341 FOXFORD CT
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4442
Practice Address - Country:US
Practice Address - Phone:770-939-6671
Practice Address - Fax:770-939-6671
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA21676207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine