Healthcare Provider Details

I. General information

NPI: 1780085126
Provider Name (Legal Business Name): DAPHNE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 DUNCAN DR BLDG 1440
HUNTER AAF GA
31409-5107
US

IV. Provider business mailing address

230 DUNCAN DR BLDG 1440
HUNTER AAF GA
31409-5107
US

V. Phone/Fax

Practice location:
  • Phone: 912-315-6500
  • Fax: 912-315-5043
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number65307
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: