Individual
ROBERT LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
417 BROAD ST S, ABBEVILLE, GA 31001-4305
(229) 467-3209
(229) 467-3212
Mailing address
417 BROAD ST S, ABBEVILLE, GA 31001-4305
(229) 467-3209
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11017
GA
363A00000X
Physician Assistant
3418
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11017
MEDICAL LICENSE
GA
Enumeration date
11/15/2019
Last updated
06/20/2022
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