Provider Demographics
NPI:1063618262
Name:ROBINSON, EUGENE (DMIN)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 CHERRY HILL PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5014
Mailing Address - Country:US
Mailing Address - Phone:404-371-8221
Mailing Address - Fax:404-243-6386
Practice Address - Street 1:240 CANDLER RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-3436
Practice Address - Country:US
Practice Address - Phone:404-371-8221
Practice Address - Fax:404-243-6386
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist