Healthcare Provider Details

I. General information

NPI: 1366306276
Provider Name (Legal Business Name): JENNIFER ROBINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 LAUREL RIDGE DR
MCDONOUGH GA
30252-8433
US

IV. Provider business mailing address

1066 LAUREL RIDGE DR
MCDONOUGH GA
30252-8433
US

V. Phone/Fax

Practice location:
  • Phone: 404-226-6721
  • Fax:
Mailing address:
  • Phone: 404-226-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: