Provider Demographics
NPI:1720266398
Name:ROBINSON, CERONNIE (PA)
Entity type:Individual
Prefix:
First Name:CERONNIE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 WOODWARD AVE SE
Mailing Address - Street 2:APT. # 202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2080
Mailing Address - Country:US
Mailing Address - Phone:678-642-2207
Mailing Address - Fax:404-963-5093
Practice Address - Street 1:3290 MEMORIAL DR STE B3
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3400
Practice Address - Country:US
Practice Address - Phone:404-534-9692
Practice Address - Fax:404-534-9934
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001644363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002158BMedicaid
GAS86517OtherUPIN
GA97WCHJSOtherMEDICARE