Provider Demographics
NPI:1871615294
Name:DR. ROBERT H. PINCKNEY
Entity type:Organization
Organization Name:DR. ROBERT H. PINCKNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PINCKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:770-775-3719
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-0018
Mailing Address - Country:US
Mailing Address - Phone:770-775-3719
Mailing Address - Fax:770-775-3888
Practice Address - Street 1:336 E 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2042
Practice Address - Country:US
Practice Address - Phone:770-775-3719
Practice Address - Fax:770-775-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA518T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GA=========OtherTAX ID
GA51983554SAMedicare ID - Type UnspecifiedMEDICARE
GA0300040001Medicare NSC