Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 038936 | GA |
NPI | 1023077088 |
---|---|
Provider Name | Mr. Richard Mark Robinson |
First Address | Conyers, GA 30013-6320 |
Second Address | Conyers, GA 30013-6320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 19/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00615469E | (05) | GA |
F85102 | (02) | GA |