Robert Land, PA
Individual provider Active NPI Physician Assistant · Abbeville, GA
NPI 1972148708 · NPPES record last updated Jun 20, 2022
Key facts
- NPI
- 1972148708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 11017 (GA)
- Practice address
- 417 Broad St S
Abbeville, GA 31001-4305 - Phone
- (229) 467-3209
- Fax
- (229) 467-3212
- NPI assigned
- Nov 15, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DMC Physician Group LLC
Crisp Regional Hospital Inc
Practice addresses (Care Compare)
119 Norman Dorminy Dr
Fitzgerald, GA 31750-9069
Phone (229) 423-5843
902 N 7TH St
Cordele, GA 31015-3234
Phone (229) 276-3100
PO Box
Fitzgerald, GA 31750
Hospital & facility affiliations
- Crisp Regional Hospital
- Dorminy Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220627003427 | GA | Practitioner - Physician Assistant | 3274960653 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3418 | SC | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crisp Regional Hospital, Inc | Current |
Accepting new patients | |
| Aiken Emergency Physicians | Current |
Accepting new patients | |
| Crisp Regional Hospital Inc | Current |
Accepting new patients | |
| DMC Physician Group LLC | Current |
Accepting new patients | |
| DMC Physician Group LLC | Current |
Accepting new patients |
Locations
417 Broad St S
Abbeville, GA 31001
Phone (229) 467-3209
902 N 7th St
Cordele, GA 31015
Phone (229) 276-3100
118 Norman Dorminy Dr
Fitzgerald, GA 31750
Phone (229) 423-9561
182 Perry House Rd
Ste H
Fitzgerald, GA 31750
Phone (229) 423-9561
246 Benjamin Hl
Fitzgerald, GA 31750
Phone (229) 391-3535
613 S Grant St
Fitzgerald, GA 31750
Phone (229) 424-0134
216 Edgefield Ave NW
Aiken, SC 29801
Phone (803) 645-4224
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 11017 | GA | Yes |
| Physician Assistant | 363A00000X | 3418 | SC |
Addresses
Primary practice location
417 Broad St S
Abbeville, GA 31001-4305
Mailing address
417 Broad St S
Abbeville, GA 31001-4305
Phone (229) 467-3209
Other practice location 1
216 Edgefield Ave NW
Aiken, SC 29801-3910
Phone (803) 648-4224
Other practice location 2
613 S Grant St
Fitzgerald, GA 31750-3315
Phone (229) 424-0134
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11017 | Other | GA | MEDICAL LICENSE |
Other providers in Abbeville, GA
- DMC Physician Group LLC
- Global Abbeville, LLC
- Ashley Handley
- High Cotton Homes, LLC
- Lisa S Hunter
- Abigail Dewitt Leone
- Brenda Faye Madison
- Kristian McRae
- MM Adult Care, Inc.
- Toni Munford
All providers in Abbeville, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.