Provider Demographics
NPI:1750422242
Name:CLARK ROBINSON, M.D.,P.C.
Entity type:Organization
Organization Name:CLARK ROBINSON, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-942-5111
Mailing Address - Street 1:6671 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1715
Mailing Address - Country:US
Mailing Address - Phone:770-942-5111
Mailing Address - Fax:770-920-8591
Practice Address - Street 1:6671 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1715
Practice Address - Country:US
Practice Address - Phone:770-942-5111
Practice Address - Fax:770-920-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034696207Q00000X
GA9601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1932133790 (NPI)OtherDR. CLARK ROBINSON
GA1508890401 (NPI)OtherDR. TAMMY J. ROBINSON
GAF48452Medicare UPIN
GAF03497Medicare UPIN
GA1508890401 (NPI)OtherDR. TAMMY J. ROBINSON