Provider Demographics
NPI:1659378560
Name:ROBERTSON, DAVID GEREALD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GEREALD
Last Name:ROBERTSON
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 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-355-4393
Mailing Address - Fax:678-412-0086
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-355-4393
Practice Address - Fax:678-412-0086
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027244207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00377011CMedicaid
GA00377011CMedicaid
GA11BDNTHMedicare ID - Type Unspecified