Provider Demographics
NPI:1972183028
Name:CAO, ROBERTO III (MS, LAT, ATC, NREMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:CAO
Suffix:III
Gender:M
Credentials:MS, LAT, ATC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 INTERNATIONAL DR APT 822A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-6627
Mailing Address - Country:US
Mailing Address - Phone:305-331-2215
Mailing Address - Fax:
Practice Address - Street 1:175 INTERNATIONAL DR APT 822A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-6627
Practice Address - Country:US
Practice Address - Phone:305-331-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAE036690146N00000X
GAAT0043412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic