Provider Demographics
NPI:1255330957
Name:ROBBINS, EDWARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:T
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E.
Other - Middle Name:TODD
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6027 WALNUT GROVE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-761-9155
Practice Address - Fax:901-683-3915
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11144208G00000X, 208G00000X
NY151037208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA96674Medicare UPIN
TN3001071Medicare PIN