MEDICARE: ROBBIE WINDHAM GEISELMAN APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	335193	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN288073	GA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	521	SC

General Provider Information

NPI Number	:	1346349784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBBIE WINDHAM GEISELMAN APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	2801 BUFORD HWY NE STE 100
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2146
Country	:	US
Telephone Number	:	678-820-7830
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR STE 110
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8585
Country	:	US
Telephone Number	:	843-501-1099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/28/2024

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