NPI 1053342774

Robert T Stark Md,pc

Organisation Preferred Provider Organization Waycross, GA

Practice location

Address: 2005 Pioneer St STE a, Waycross, GA 31501-6205
Phone: (912) 287-1621
Fax: (912) 287-1817

Authorised official

Name: Robert Timothy Stark
Title: Physician
Phone: (912) 287-1621

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 045632 (GA)

Other Preferred Provider Organization providers in Georgia →

Registry record

NPI: 1053342774
Entity type: Organization
NPI issued: 5 Jul 2006
Record last updated: 1 Oct 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.