MEDICARE: MR. RICHARD MARK ROBINSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	038936	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023077088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD MARK ROBINSON M.D.

Provider Business Mailing Address
First Line	:	3240 AVALON BLVD
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6320
Country	:	US
Telephone Number	:	770-860-1133
Fax Number	:	770-860-1599

Provider Business Practice Location Address
First Line	:	3240 AVALON BLVD
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6320
Country	:	US
Telephone Number	:	770-860-1133
Fax Number	:	770-860-1599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	11/19/2011

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