Provider Demographics
NPI:1417568031
Name:ROBINSON, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:FRUITHURST
Mailing Address - State:AL
Mailing Address - Zip Code:36262-3705
Mailing Address - Country:US
Mailing Address - Phone:678-836-7748
Mailing Address - Fax:
Practice Address - Street 1:740 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3249
Practice Address - Country:US
Practice Address - Phone:770-748-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician