Healthcare Provider Details

I. General information

NPI: 1932797073
Provider Name (Legal Business Name): JEAN HARRIETT ROBINSON HEALTHCARE PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 KILLIAN HILL RD SW
LILBURN GA
30047-3137
US

IV. Provider business mailing address

5352 DEEP SPRINGS DR
STONE MOUNTAIN GA
30087-3628
US

V. Phone/Fax

Practice location:
  • Phone: 770-572-0280
  • Fax:
Mailing address:
  • Phone: 770-572-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: