Healthcare Provider Details

I. General information

NPI: 1588639496
Provider Name (Legal Business Name): JUSTIN DAVID ROBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CHURCH ST
HAYESVILLE NC
28904-9688
US

IV. Provider business mailing address

241 CHURCH ST
HAYESVILLE NC
28904-9688
US

V. Phone/Fax

Practice location:
  • Phone: 828-389-6383
  • Fax: 828-389-6303
Mailing address:
  • Phone: 931-289-4201
  • Fax: 931-289-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24848
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020-04139
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: