Healthcare Provider Details

I. General information

NPI: 1639032261
Provider Name (Legal Business Name): SHAKETEA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 SANDY TRAIL DR
HAMPTON GA
30228-5317
US

IV. Provider business mailing address

1780 SANDY TRAIL DR
HAMPTON GA
30228-5317
US

V. Phone/Fax

Practice location:
  • Phone: 404-695-8621
  • Fax:
Mailing address:
  • Phone: 404-695-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN295402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: