Provider Demographics
NPI:1427760974
Name:ROBINSON, TYMETRIC ANTOIN (MD)
Entity type:Individual
Prefix:
First Name:TYMETRIC
Middle Name:ANTOIN
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-2873
Mailing Address - Country:US
Mailing Address - Phone:662-694-5726
Mailing Address - Fax:
Practice Address - Street 1:338 GREEN ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2873
Practice Address - Country:US
Practice Address - Phone:662-694-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR411322363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical CareGroup - Single Specialty