Provider Demographics
NPI:1154499978
Name:ROBINSON, REGINALD JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:JEROME
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:106 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2917
Mailing Address - Country:US
Mailing Address - Phone:912-527-1088
Mailing Address - Fax:912-527-1126
Practice Address - Street 1:5354 REYNOLDS ST STE 420
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6011
Practice Address - Country:US
Practice Address - Phone:912-527-1000
Practice Address - Fax:912-527-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46638207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00813084AMedicaid
GA160051842OtherRR MEDICARE
SCG46638OtherSC MEDICAID
GA00813084AMedicaid
SCG46638OtherSC MEDICAID