Healthcare Provider Details

I. General information

NPI: 1386625325
Provider Name (Legal Business Name): ROBERT EARL SAUNDERS JR. LICENSED CLINICAL SO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 EMORY RD
BLAINE TN
37709-2420
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-933-4110
  • Fax: 865-933-4729
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW4903
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: