Healthcare Provider Details

I. General information

NPI: 1528238185
Provider Name (Legal Business Name): ROBINS FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HAVEN CRST
BONAIRE GA
31005-4826
US

IV. Provider business mailing address

103 HAVEN CRST
BONAIRE GA
31005-4826
US

V. Phone/Fax

Practice location:
  • Phone: 478-287-6040
  • Fax: 478-225-9721
Mailing address:
  • Phone: 478-287-6040
  • Fax: 478-225-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number058007
License Number StateGA

VIII. Authorized Official

Name: DR. MARIE MYRTHA SEVERE
Title or Position: FAMILY PHYSICIAN
Credential: M.D.
Phone: 478-714-8667