MEDICARE: SALIH ROBINSON

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1568765824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALIH ROBINSON

Provider Business Mailing Address
First Line	:	4137 SANDY LAKE DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-3859
Country	:	US
Telephone Number	:	404-944-0465
Fax Number	:	770-593-3248

Provider Business Practice Location Address
First Line	:	2511 LANTRAC CT
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035
Country	:	US
Telephone Number	:	770-593-8033
Fax Number	:	770-593-3248

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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