Provider Demographics
NPI:1407407828
Name:ROBINSON, JARED K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12175 WILDWOOD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1890
Mailing Address - Country:US
Mailing Address - Phone:678-756-0038
Mailing Address - Fax:
Practice Address - Street 1:250 PARKBROOKE PL STE 300
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6401
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:770-928-2601
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine