Provider Demographics
NPI:1578724696
Name:ROBINSON, CANDICE L (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CLIFTON RD NE
Mailing Address - Street 2:MS A-19
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4018
Mailing Address - Country:US
Mailing Address - Phone:404-518-3313
Mailing Address - Fax:
Practice Address - Street 1:150 N 18TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3232
Practice Address - Country:US
Practice Address - Phone:602-542-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNMD0000047851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program