Provider Demographics
NPI:1326253675
Name:ROBINSON, CAROLYN JOHNSON (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JOHNSON
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 MEAD CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-9209
Mailing Address - Country:US
Mailing Address - Phone:404-606-0942
Mailing Address - Fax:404-464-0249
Practice Address - Street 1:1701 HARDEE AVE
Practice Address - Street 2:
Practice Address - City:FORT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330
Practice Address - Country:US
Practice Address - Phone:404-464-0241
Practice Address - Fax:404-464-0249
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151265163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD000Medicare UPIN