Healthcare Provider Details

I. General information

NPI: 1477055606
Provider Name (Legal Business Name): JOHN W ROBISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 1ST ST STE A
VIDALIA GA
30474-8674
US

IV. Provider business mailing address

3301 E 1ST ST STE A
VIDALIA GA
30474-8674
US

V. Phone/Fax

Practice location:
  • Phone: 312-537-4411
  • Fax: 912-538-8485
Mailing address:
  • Phone: 312-537-4411
  • Fax: 912-538-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number100000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: