Provider Demographics
NPI:1629184395
Name:MARSHBURN, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:MARSHBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MEDICAL CENTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1085
Mailing Address - Country:US
Mailing Address - Phone:706-335-5155
Mailing Address - Fax:706-335-5256
Practice Address - Street 1:45 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1085
Practice Address - Country:US
Practice Address - Phone:706-335-5155
Practice Address - Fax:706-335-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000410484AMedicaid
GA000410484AMedicaid
GA08BDBLQMedicare ID - Type Unspecified