Provider Demographics
NPI:1912062522
Name:ROBINSON, JENNIFER P (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-9775
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:404-364-4752
Practice Address - Street 1:1938 PEACHTREE ROAD NW
Practice Address - Street 2:KAISER PERMANENTE HOSPITAL SERVICES
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-603-1300
Practice Address - Fax:404-603-1314
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75280Medicare UPIN
11SCDPRMedicare ID - Type Unspecified