1548300353 NPI number — MRS. ERIKA V ROBINSON

Table of content: MRS. ERIKA V ROBINSON (NPI 1548300353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548300353 NPI number — MRS. ERIKA V ROBINSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
ERIKA
Provider Middle Name:
V
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEARD
Provider Other First Name:
ERIKA
Provider Other Middle Name:
VONTRECYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548300353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4979 TADMORE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHONIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30038-2237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-551-0222
Provider Business Mailing Address Fax Number:
770-696-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 SAVOY DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30341-1072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-298-9484
Provider Business Practice Location Address Fax Number:
678-826-4033
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP006022 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10034815 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 305487 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251913439 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251913439 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 440163644A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 440163644D . This is a "PEACHSTATE" identifier . This identifiers is of the category "OTHER".




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