Provider Demographics
NPI:1730206269
Name:ROBINSON, CHARLENE Y (MD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:Y
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1462 MONTREAL ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6931
Mailing Address - Country:US
Mailing Address - Phone:678-580-5958
Mailing Address - Fax:770-807-0978
Practice Address - Street 1:1462 MONTREAL ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6931
Practice Address - Country:US
Practice Address - Phone:678-580-5958
Practice Address - Fax:770-807-0978
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000488903GMedicaid
GA202I080827Medicare PIN
GA511G700201Medicare PIN
GA511I080121Medicare PIN