MEDICARE: ROBINS FAMILY MEDICINE

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	261Q00000X	Clinic/Center	058007	GA

General Provider Information

NPI Number	:	1528238185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBINS FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	103 HAVEN CRST
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-4826
Country	:	US
Telephone Number	:	478-287-6040
Fax Number	:	478-225-9721

Provider Business Practice Location Address
First Line	:	103 HAVEN CRST
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-4826
Country	:	US
Telephone Number	:	478-287-6040
Fax Number	:	478-225-9721

Authorized Official
Title or Position	:	FAMILY PHYSICIAN
Name	:	DR. MARIE MYRTHA SEVERE
Credential	:	M.D.
Telephone Number	:	478-714-8667

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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Directions to “ROBINS FAMILY MEDICINE ” Practice Location

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