Basic Information
| Provider Information | |||||||||
| NPI: | 1104919737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LITTLE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 CANAAN GLEN WAY, S.W. | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043460032 | ||||||||
| FaxNumber: | 4043497274 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 N. COBB ST. | ||||||||
| Address2: | |||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784543795 | ||||||||
| FaxNumber: | 4784543969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 028355 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00413256B | 05 | GA | MEDICAID |