Provider Demographics
NPI:1750122149
Name:ROBINSON, ELYSSA SHARVON (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:SHARVON
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
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 24193
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403-4193
Mailing Address - Country:US
Mailing Address - Phone:912-312-9823
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 24193
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31403-4193
Practice Address - Country:US
Practice Address - Phone:912-312-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAB4L2R3S5261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service