Provider Demographics
NPI:1548858335
Name:CAREY, ROBERT TODD (LP,CP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:CAREY
Suffix:
Gender:M
Credentials:LP,CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 DUBLIN HWY
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-3819
Mailing Address - Country:US
Mailing Address - Phone:478-230-8739
Mailing Address - Fax:478-559-3099
Practice Address - Street 1:1111 GRIFFIN AVE STE 1A
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9104
Practice Address - Country:US
Practice Address - Phone:478-559-3097
Practice Address - Fax:478-559-3099
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty