Provider Demographics
NPI:1174615116
Name:ROBINSON, IRA CHARLES II (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:CHARLES
Last Name:ROBINSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 EAGLES WALK
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6335
Mailing Address - Country:US
Mailing Address - Phone:770-506-0100
Mailing Address - Fax:770-507-2597
Practice Address - Street 1:100 EAGLES WALK
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6335
Practice Address - Country:US
Practice Address - Phone:770-506-0100
Practice Address - Fax:770-507-2597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA047830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00932357AMedicaid
GA00932357AMedicaid
GA11BDVGJMedicare ID - Type Unspecified