Provider Demographics
NPI:1770246241
Name:ROBINSON, RONNEY (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:RONNEY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 CAROLYN ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3550
Mailing Address - Country:US
Mailing Address - Phone:404-380-0008
Mailing Address - Fax:
Practice Address - Street 1:1065 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3911
Practice Address - Country:US
Practice Address - Phone:404-380-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist