Provider Demographics
NPI:1558895961
Name:ROBINSON, HENDERICA C
Entity Type:Individual
Prefix:
First Name:HENDERICA
Middle Name:C
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 1:3605 HILLWAY DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31606-1618
Mailing Address - Country:US
Mailing Address - Phone:229-834-4956
Mailing Address - Fax:
Practice Address - Street 1:3605 HILLWAY DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31606-1618
Practice Address - Country:US
Practice Address - Phone:229-834-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor