Healthcare Provider Details

I. General information

NPI: 1730283201
Provider Name (Legal Business Name): JERRY EDWARD ROBBINS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 POINT MALLARD PKWY SE STE N
DECATUR AL
35603-5760
US

IV. Provider business mailing address

885 N CEDAR COVE RD
HARTSELLE AL
35640-4957
US

V. Phone/Fax

Practice location:
  • Phone: 256-432-2822
  • Fax: 256-432-2825
Mailing address:
  • Phone: 256-751-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00021372
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21372
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: