Provider Demographics
NPI:1750631602
Name:BANKS, ROBIN ELAINE (LMT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ELAINE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 NORTHLAKE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4100
Mailing Address - Country:US
Mailing Address - Phone:770-493-6360
Mailing Address - Fax:770-493-6350
Practice Address - Street 1:2185 NORTHLAKE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4109
Practice Address - Country:US
Practice Address - Phone:770-493-6360
Practice Address - Fax:770-493-6350
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist