Active NPI
Roberd Maner Bostick, M.D.
- Family Medicine Physician
- Atlanta, GA
National Provider Identifier
1194934703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 057435
- Practice address
- Of Epidemiology
1518 Clifton Road NE
Atlanta, GA 30322-4201 - Phone
- (404) 727-2671
- Fax
- (404) 727-8737
- NPI assigned
- May 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 057435 | GA | Primary |
Addresses
Primary practice location
Of Epidemiology
1518 Clifton Road NE
Atlanta, GA 30322-4201
Mailing address
Of Epidemiology
1518 Clifton Road NE
Atlanta, GA 30322-4201
Phone (404) 727-2671
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31896 | Other | MN | STATE MED. LIC. NO. |
| 9401136 | Other | NC | STATE MED. LIC. NO. |
| 057435 | Other | GA | STATE MED. LIC. NO. |
| 8373 | Other | SC | STATE MED. LIC. NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8373 | SC | MD | Pharmacist |
| 057435 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1194934703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "OF EPIDEMIOLOGY",
"address_2": "1518 CLIFTON ROAD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303224201",
"telephone_number": "404-727-2671",
"fax_number": "404-727-8737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "OF EPIDEMIOLOGY",
"address_2": "1518 CLIFTON ROAD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303224201",
"telephone_number": "404-727-2671",
"fax_number": "404-727-8737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSTICK",
"first_name": "ROBERD",
"middle_name": "MANER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "057435",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MED. LIC. NO.",
"identifier": "31896",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MED. LIC. NO.",
"identifier": "9401136",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MED. LIC. NO.",
"identifier": "057435",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MED. LIC. NO.",
"identifier": "8373",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.