Basic Information
| Provider Information | |||||||||
| NPI: | 1073927091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 NORTHSIDE BLVD STE 3100 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709777777 | ||||||||
| FaxNumber: | 8552838851 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE BLVD STE 3100 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709777777 | ||||||||
| FaxNumber: | 8552838851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2014018997 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 11262248-1205 | UT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | 85499 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.