Provider Demographics
NPI:1336297571
Name:ROBINSON, JONATHAN CRAWFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CRAWFORD
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DRIVE
Mailing Address - Street 2:BLDG 200, SUITE 202
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-353-8188
Mailing Address - Fax:706-613-0848
Practice Address - Street 1:700 SUNSET DRIVE
Practice Address - Street 2:BLDG 200, SUITE 202
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-353-8188
Practice Address - Fax:706-613-0848
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAPSY001974103TC0700X
GA001974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00693437AMedicaid
GA68BBDNXMedicare PIN
GA68BBDNXMedicare ID - Type UnspecifiedLICENSED PSYCHOLOGIST
GA00693437AMedicaid