Provider Demographics
NPI:1346638285
Name:BLEDSOE, ROBIN RAIKEN (PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RAIKEN
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 BOULEVARD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1468
Mailing Address - Country:US
Mailing Address - Phone:404-658-1500
Mailing Address - Fax:404-658-1535
Practice Address - Street 1:458 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1836
Practice Address - Country:US
Practice Address - Phone:404-815-1811
Practice Address - Fax:404-815-1855
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN126178CNS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult