Healthcare Provider Details

I. General information

NPI: 1003452319
Provider Name (Legal Business Name): DANNY ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 COMMONS BOULEVARD
AUGUSTA GA
30909
US

IV. Provider business mailing address

2929 ARROWWOOD CIR
HEPHZIBAH GA
30815-7075
US

V. Phone/Fax

Practice location:
  • Phone: 706-843-6242
  • Fax:
Mailing address:
  • Phone: 706-836-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number008972
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: