Basic Information
| Provider Information | |||||||||
| NPI: | 1821582123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCSHANE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067217005 | ||||||||
| FaxNumber: | 7064463546 | ||||||||
| Practice Location | |||||||||
| Address1: | 3121 PEACH ORCHARD RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309063527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067217005 | ||||||||
| FaxNumber: | 7064463546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2018 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 010094 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.