Individual
CERONNIE ROBINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3290 MEMORIAL DR STE B3, DECATUR, GA 30032-3400
(404) 534-9692
(404) 534-9934
Mailing address
123 WOODWARD AVE SE, APT. # 202, ATLANTA, GA 30312-2080
(678) 642-2207
(404) 963-5093
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001644
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002158B
—
GA
01
—
97WCHJS
MEDICARE
GA
01
—
S86517
UPIN
GA
Enumeration date
02/06/2008
Last updated
05/01/2009
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