Provider Demographics
NPI:1114150018
Name:ROBINSON, KAWANNA (LNHA/ LPN)
Entity Type:Individual
Prefix:
First Name:KAWANNA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LNHA/ LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 LONG CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7733
Mailing Address - Country:US
Mailing Address - Phone:404-552-3218
Mailing Address - Fax:
Practice Address - Street 1:1122 MONTICELLO ST SW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2306
Practice Address - Country:US
Practice Address - Phone:470-205-3504
Practice Address - Fax:678-660-3827
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069920164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse