Provider Demographics
NPI:1205926920
Name:TEACHMAN, ROBERT JOHN (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:TEACHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:776 DANIEL ELLIS DR
Practice Address - Street 2:SUITE 1-B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3094
Practice Address - Country:US
Practice Address - Phone:843-795-0300
Practice Address - Fax:843-795-1952
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009305Medicaid
SCP01157479OtherRR-MEDICARE
SCP01157479OtherRR-MEDICARE