Provider Demographics
NPI:1558390104
Name:TODD, ROBIN S (NP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:TODD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD STE 190
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4788
Mailing Address - Country:US
Mailing Address - Phone:912-466-7250
Mailing Address - Fax:912-466-7253
Practice Address - Street 1:3025 SHRINE RD STE 190
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4788
Practice Address - Country:US
Practice Address - Phone:912-466-7250
Practice Address - Fax:912-466-7253
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118522163W00000X, 363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000808728CMedicaid
GA50BBDBVMedicare ID - Type UnspecifiedWARE HD