Healthcare Provider Details

I. General information

NPI: 1659731313
Provider Name (Legal Business Name): ROBIN ANN LOCKHART FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN ANN CLARK FNP-C

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST BA-9413
AUGUSTA GA
30912
US

IV. Provider business mailing address

7212 GOLDVIEW DRIVE
AIKEN SC
29801
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2861
  • Fax: 706-721-7136
Mailing address:
  • Phone: 716-378-5562
  • Fax: 706-722-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN219964
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: