Healthcare Provider Details

I. General information

NPI: 1447799333
Provider Name (Legal Business Name): MRS. JAMIE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JAMIE DICKEY

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 STERLING OAKS CIR NE
BROOKHAVEN GA
30319-4129
US

IV. Provider business mailing address

1944 STERLING OAKS CIR NE
BROOKHAVEN GA
30319-4129
US

V. Phone/Fax

Practice location:
  • Phone: 678-464-4418
  • Fax:
Mailing address:
  • Phone: 678-464-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86001687
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: