Provider Demographics
NPI:1144844374
Name:PHILIPPE, ROBERSON JEAN (PRIVATE HOME CARE)
Entity type:Individual
Prefix:
First Name:ROBERSON
Middle Name:JEAN
Last Name:PHILIPPE
Suffix:
Gender:M
Credentials:PRIVATE HOME CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PEACHTREE RD NE STE 1800
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1064
Mailing Address - Country:US
Mailing Address - Phone:678-596-3904
Mailing Address - Fax:
Practice Address - Street 1:3340 PEACHTREE RD NE STE 1800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1064
Practice Address - Country:US
Practice Address - Phone:678-596-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 251J00000X
GAPHCP0107093747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251G00000XAgenciesHospice Care, Community Based
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA82-4635716OtherIRS