Provider Demographics
NPI:1225075815
Name:ROBINSON, JOE SAM JR
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:SAM
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:SAM
Other - Last Name:ROBINSON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:840 PINE STREET
Mailing Address - Street 2:SUITE 880
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1717
Mailing Address - Country:US
Mailing Address - Phone:478-743-7092
Mailing Address - Fax:478-743-6293
Practice Address - Street 1:840 PINE ST
Practice Address - Street 2:SUITE 880
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2100
Practice Address - Country:US
Practice Address - Phone:478-743-7092
Practice Address - Fax:478-743-6293
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022465174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00232075AMedicaid
GAE00294Medicare UPIN