MEDICARE: MISS ROBIN LYNN BOSTON B.S., PP

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	171W00000X	Contractor	055194398	GA

General Provider Information

NPI Number	:	1649728510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ROBIN LYNN BOSTON B.S., PP

Provider Business Mailing Address
First Line	:	5167 WARNER ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-3938
Country	:	US
Telephone Number	:	404-859-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	5167 WARNER ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-3938
Country	:	US
Telephone Number	:	404-859-0011
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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