Provider Demographics
NPI:1386740108
Name:ROBINSON, KEISHA (MD)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26040
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221
Mailing Address - Country:US
Mailing Address - Phone:478-475-1299
Mailing Address - Fax:478-405-7928
Practice Address - Street 1:840 PINE STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-742-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045037207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000866566CMedicaid
GA16BBCLZMedicare ID - Type Unspecified
GA000866566CMedicaid