Provider Demographics
NPI:1962471516
Name:ROBERT B. RHOADES MD, PC
Entity Type:Organization
Organization Name:ROBERT B. RHOADES MD, PC
Other - Org Name:AUGUSTA ALLERGY AND DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-855-1520
Mailing Address - Street 1:4485 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4255
Mailing Address - Country:US
Mailing Address - Phone:706-855-1520
Mailing Address - Fax:706-860-4250
Practice Address - Street 1:4485 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4255
Practice Address - Country:US
Practice Address - Phone:706-855-1520
Practice Address - Fax:706-860-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13420207KA0200X, 207Q00000X
GA18599207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1643Medicare PIN