Provider Demographics
NPI:1912942418
Name:SPINOLA, ROBSON S (DPM)
Entity Type:Individual
Prefix:
First Name:ROBSON
Middle Name:S
Last Name:SPINOLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5337
Mailing Address - Country:US
Mailing Address - Phone:912-283-6471
Mailing Address - Fax:912-283-1618
Practice Address - Street 1:331 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0245
Practice Address - Country:US
Practice Address - Phone:912-427-9990
Practice Address - Fax:912-427-9993
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000904213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00109461OtherRAILROAD MEDICARE
GA000955732BMedicaid
GA48SCCNTMedicare PIN
5243400001Medicare NSC
GAU87831Medicare UPIN