Healthcare Provider Details

I. General information

NPI: 1982554028
Provider Name (Legal Business Name): OLLIS SAXON ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

644 WATSON BAY
STONE MOUNTAIN GA
30087-6122
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-6918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: