Individual
DR. ROBERT GLENN KIRTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 W NORTHSIDE DR # F, VALDOSTA, GA 31602-1714
(229) 262-1981
(229) 375-0392
Mailing address
101 W NORTHSIDE DR # F, VALDOSTA, GA 31602-1714
(229) 262-1981
(229) 375-0392
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01069431A
IN
208100000X
Physical Medicine & Rehabilitation Physician
82327
GA
208D00000X
General Practice Physician
01069431A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003220961C
—
GA
Enumeration date
06/12/2009
Last updated
07/13/2020
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