Provider Demographics
NPI:1982692612
Name:SNOW, ROBERT JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:SNOW
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:519 BROAD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-1734
Mailing Address - Country:US
Mailing Address - Phone:706-767-8347
Mailing Address - Fax:404-393-4033
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-767-8347
Practice Address - Fax:404-393-4033
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA983424367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
Q50703Medicare UPIN
GA43BBBPFMedicare ID - Type Unspecified