Provider Demographics
NPI:1154678134
Name:ROBINSON, ELIZABETH JANE (AUDCCC-A)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:JANE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:AUDCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3202
Mailing Address - Country:US
Mailing Address - Phone:478-741-1800
Mailing Address - Fax:
Practice Address - Street 1:540 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3202
Practice Address - Country:US
Practice Address - Phone:478-741-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003908231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD003908OtherGEORGIA STATE LICENSE