Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Gary Robertson, IDC

Individual provider Medical Physician Assistant · NPI 1790034296

Mr. Gary Robertson, IDC is a Medical Physician Assistant in Kings Bay, Georgia. Licensed in Connecticut. Registered with an NPI since 2012.

Licensed in
CT
In the registry since
2012

Practice location Address checks out

1059 Uss Mariano Villejo Ave
Kings Bay, GA 31547
Phone: (912) 573-6599
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X (CT)

Record details

NPI number1790034296
Entity typeIndividual (Type 1)
GenderMale
Credentials IDC
Sole proprietorNo
NPI enumeratedAugust 30, 2012
Last updated in NPPESMarch 31, 2025
Certification dateMarch 26, 2025
Mailing address1059 Uss Mariano Villejo Ave, Kings Bay, GA 31547

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