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Contact Information

ROBINWILD INTEGRATED MEDICINE LLC
507 WATSON BAY
STONE MOUNTAIN, GA30087-6121
 Phone: 678-651-4022
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
 

Addiction (Substance Use Disorder)

101YA0400X
 

Family

103TF0000X 62 Psychologist, Clinical
 

Mental Health

101YM0800X
 

Prescribing (Medical)

103TP0016X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for ROBINWILD INTEGRATED MEDICINE LLC

NPI # 1700471133
LBN Legal business name ROBINWILD INTEGRATED MEDICINE LLC
Authorized official TIFFANI WILDER - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 03/08/2021
Last updated 03/08/2021 - About 5 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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