Individual
DR. ROBERT W WETHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 LAKE PARK DR SE, SMYRNA, GA 30080-7611
(678) 556-9411
(678) 556-9413
Mailing address
P.O. BOX 3429, AUGUSTA, GA 30914-3429
(706) 737-4575
(706) 731-5289
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
044376
GA
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
044376
GA
207ZP0101X
Anatomic Pathology Physician
044376
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000968019B
—
GA
01
—
272341992
TRICARE
—
Enumeration date
01/17/2006
Last updated
10/31/2013
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