Provider Demographics
NPI:1821855560
Name:GERVIN, ROBERT T SR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:GERVIN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FOREST RIDGE DRIVE
Mailing Address - Street 2:ALBANY
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721
Mailing Address - Country:US
Mailing Address - Phone:229-438-0321
Mailing Address - Fax:229-405-8304
Practice Address - Street 1:3300 FOREST RIDGE DRIVE
Practice Address - Street 2:ALBANY
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721
Practice Address - Country:US
Practice Address - Phone:229-438-0321
Practice Address - Fax:229-405-8304
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-R-1614251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health