Basic Information
| Provider Information | |||||||||
| NPI: | 1255315016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGUSZEWSKI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 AMBULANCE DR. | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708388787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 905 DIXIE ST | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301174417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708125831 | ||||||||
| FaxNumber: | 7708125832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 032792 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0004296684 | 05 | GA | MEDICAID | 00429668C | 05 | GA | MEDICAID |