Provider Demographics
NPI:1437561370
Name:ROBINSON, SHAE ALA (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:SHAE
Middle Name:ALA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 E CONFEDERATE AVE SE UNIT DN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2562
Mailing Address - Country:US
Mailing Address - Phone:313-574-2179
Mailing Address - Fax:
Practice Address - Street 1:1661 W MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1717
Practice Address - Country:US
Practice Address - Phone:770-223-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant