Healthcare Provider Details

I. General information

NPI: 1427591692
Provider Name (Legal Business Name): JESSICA H. ROBBINS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LACY ST NW STE 150
MARIETTA GA
30060-1273
US

IV. Provider business mailing address

30 5TH ST NE UNIT 101
ATLANTA GA
30308-1141
US

V. Phone/Fax

Practice location:
  • Phone: 770-514-6760
  • Fax:
Mailing address:
  • Phone: 205-812-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1132
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number004064
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: