Individual
MR. ROBERT JAY MUTERSPAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
802 18TH ST E, TIFTON, GA 31794-3661
(229) 386-9333
(229) 386-1666
Mailing address
2400 BELLEVUE RD, SUITE 21-A, DUBLIN, GA 31021-2885
(478) 275-7202
(478) 274-8418
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003261
GA
363AM0700X
Medical Physician Assistant
003261
GA
363AS0400X
Surgical Physician Assistant
003261
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002323A
—
GA
Enumeration date
06/01/2005
Last updated
03/12/2015
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