Individual
MR. GARY ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
I.D.C
Contact information
Practice address
1059 USS MARIANO VILLEJO AVE, KINGS BAY, GA 31547
(912) 573-6599
Mailing address
1059 USS MARIANO VILLEJO AVE, KINGS BAY, GA 31547
(912) 573-6599
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1132
US NAVY
FL
Enumeration date
08/30/2012
Last updated
03/31/2025
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