Provider Demographics
NPI:1497886253
Name:ROBIN SCOGGIN, OD, INC.
Entity Type:Organization
Organization Name:ROBIN SCOGGIN, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-378-3000
Mailing Address - Street 1:203 GLENN MILNER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3239
Mailing Address - Country:US
Mailing Address - Phone:706-378-3000
Mailing Address - Fax:706-378-3087
Practice Address - Street 1:203 GLENN MILNER BLVD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3239
Practice Address - Country:US
Practice Address - Phone:706-378-3000
Practice Address - Fax:706-378-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1029261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT90932Medicare UPIN
GA256943476Medicare ID - Type Unspecified