Provider Demographics
NPI:1871586115
Name:WIRT, ROBERT C (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:WIRT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:601 S ENOTA DR NE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2400
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:597 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2545
Practice Address - Country:US
Practice Address - Phone:770-219-7777
Practice Address - Fax:770-219-7778
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-02-19
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Provider Licenses
StateLicense IDTaxonomies
GA026686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00365538CMedicaid
GA01BDHWNMedicare PIN
GAD42269Medicare UPIN