Healthcare Provider Details

I. General information

NPI: 1013841642
Provider Name (Legal Business Name): CLINYSE ROBINSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N DOOLY ST
MONTEZUMA GA
31063-1510
US

IV. Provider business mailing address

213 MOORE AVE
ALBANY GA
31705-4019
US

V. Phone/Fax

Practice location:
  • Phone: 478-316-6005
  • Fax:
Mailing address:
  • Phone: 786-414-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: