Healthcare Provider Details

I. General information

NPI: 1194041566
Provider Name (Legal Business Name): ROBIN WALSH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2010
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N JACKSON ST
ALBANY GA
31701-2308
US

IV. Provider business mailing address

506 N JACKSON ST
ALBANY GA
31701-2308
US

V. Phone/Fax

Practice location:
  • Phone: 229-889-7200
  • Fax: 229-889-7393
Mailing address:
  • Phone: 229-889-7200
  • Fax: 229-889-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002730
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: