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General NPI Number Information
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NPI Number | 1720266398
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Entity Type | Individual
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Provider Name | CERONNIE ROBINSON P.A.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 3290 MEMORIAL DR STE B3
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City | DECATUR
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State | GA
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Zip | 30032-3400
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Country | US
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Telephone | 404-534-9692
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Fax | 404-534-9934
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Provider Business Mailing Address
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Address Line | 123 WOODWARD AVE SE APT. # 202
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City | ATLANTA
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State | GA
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Zip | 30312-2080
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Country | US
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Telephone | 678-642-2207
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Fax | 404-963-5093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001644
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License Number State | GA
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