Healthcare Provider Details

I. General information

NPI: 1194013201
Provider Name (Legal Business Name): ROBIN A CRISWELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

PO BOX 2208 DEPT 40227
ANNISTON AL
36202-2208
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-3232
  • Fax:
Mailing address:
  • Phone: 256-235-5121
  • Fax: 256-231-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN151479
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: