Provider Demographics
NPI:1821007642
Name:ROBINSON, KIT HAROLD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIT
Middle Name:HAROLD
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-0603
Mailing Address - Country:US
Mailing Address - Phone:229-794-3003
Mailing Address - Fax:229-794-3804
Practice Address - Street 1:950 GA HIGHWAY 122 W
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1061
Practice Address - Country:US
Practice Address - Phone:229-794-3003
Practice Address - Fax:229-794-3804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00962156BMedicaid
GA00962156AMedicaid