Robert T Stark MD,PC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

045632 Issued in GA

Legal business name

ROBERT T STARK MD,PC

Practice address

2005 Pioneer St Ste a
Waycross, GA 31501-6205

Phone

(912) 287-1621

Fax

(912) 287-1817

NPI assigned

Jul 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Timothy Stark, M.D.

Title

Physician

Phone

(912) 287-1621

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285891200000",
    "number": "1053342774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 PIONEER ST STE A",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016205",
            "telephone_number": "912-287-1621",
            "fax_number": "912-287-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 PIONEER ST STE A",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016205",
            "telephone_number": "912-287-1621",
            "fax_number": "912-287-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT T STARK MD,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2010-10-01",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "912-287-1621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "GA",
            "license": "045632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Waycross, GA
• Providers in Waycross, GA by specialty
• Preferred Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.