Healthcare Provider Details

I. General information

NPI: 1689886137
Provider Name (Legal Business Name): LINDA MUNRO PSY D PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST BLDG 700/700-A
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

655 7TH ST BLDG 700/700-A
ROBINS AFB GA
31098-2227
US

V. Phone/Fax

Practice location:
  • Phone: 478-222-4834
  • Fax: 478-327-8400
Mailing address:
  • Phone: 478-222-4834
  • Fax: 478-327-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberPY4016
License Number StateFL

VIII. Authorized Official

Name: LINDA NAIL MUNRO
Title or Position: OWNER
Credential: PSY D
Phone: 478-396-3084