Provider Demographics
NPI:1538161252
Name:DAMBACH, ROBERT THOMAS JR (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:DAMBACH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4720 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGARHILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3480
Mailing Address - Country:US
Mailing Address - Phone:770-945-1990
Mailing Address - Fax:770-945-3631
Practice Address - Street 1:4720 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:SUGARHILL
Practice Address - State:GA
Practice Address - Zip Code:30518-3480
Practice Address - Country:US
Practice Address - Phone:770-945-1990
Practice Address - Fax:770-945-3631
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52022005OtherBLUE CROSS BLUE SHIELD
GA52022005OtherBLUE CROSS BLUE SHIELD
11BDTSNMedicare ID - Type Unspecified