Provider Demographics
NPI:1629088034
Name:MONETT, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:MONETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3404
Mailing Address - Country:US
Mailing Address - Phone:404-377-3436
Mailing Address - Fax:404-371-0019
Practice Address - Street 1:200 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3404
Practice Address - Country:US
Practice Address - Phone:404-377-3436
Practice Address - Fax:404-371-0019
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA19408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080069329OtherMEDICARE RAILROAD
GA00671052AMedicaid
GA00671052AMedicaid
GA080069329OtherMEDICARE RAILROAD