Provider Demographics
NPI:1073859294
Name:ROBINSON, MIRANDA MONEKE
Entity type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:MONEKE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 OAK ST
Mailing Address - Street 2:
Mailing Address - City:RAY CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31645-8437
Mailing Address - Country:US
Mailing Address - Phone:229-560-0231
Mailing Address - Fax:
Practice Address - Street 1:95 OAK ST
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-8437
Practice Address - Country:US
Practice Address - Phone:229-560-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker