Gary Robertson, I.D.C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1059 Uss Mariano Villejo Ave
Kings Bay, GA 31547

Phone

(912) 573-6599

NPI assigned

Aug 30, 2012

Last updated

Mar 31, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1790034296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 USS MARIANO VILLEJO AVE",
            "city": "KINGS BAY",
            "state": "GA",
            "postal_code": "31547",
            "telephone_number": "912-573-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 USS MARIANO VILLEJO AVE",
            "city": "KINGS BAY",
            "state": "GA",
            "postal_code": "31547",
            "telephone_number": "912-573-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "GARY",
        "name_prefix": "Mr.",
        "credential": "I.D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-30",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US NAVY",
            "identifier": "1132",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Kings Bay, GA
• Providers in Kings Bay, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.