Basic Information
| Provider Information | |||||||||
| NPI: | 1568459063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENNIS | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 WHITCHER ST NE | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704223290 | ||||||||
| FaxNumber: | 7704220287 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 WHITCHER ST NE | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704223290 | ||||||||
| FaxNumber: | 7704220287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 02/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 056538 | GA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 549898975B | 05 | GA | MEDICAID | 549898975E | 05 | GA | MEDICAID | 549898975C | 05 | GA | MEDICAID | 549898975F | 05 | GA | MEDICAID |