Provider Demographics
NPI:1912908633
Name:ROBINSON, PHILLIP L (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ENTERPRISE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9227
Mailing Address - Country:US
Mailing Address - Phone:706-321-0476
Mailing Address - Fax:706-321-2508
Practice Address - Street 1:106 ENTERPRISE CT
Practice Address - Street 2:A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3089
Practice Address - Country:US
Practice Address - Phone:706-321-2555
Practice Address - Fax:706-323-0245
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA041480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBSKHMedicare ID - Type UnspecifiedMD