Healthcare Provider Details

I. General information

NPI: 1831756782
Provider Name (Legal Business Name): MIRIAH ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 08/06/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CARTER ST
CHATTANOOGA TN
37402-5017
US

IV. Provider business mailing address

1101 CARTER ST
CHATTANOOGA TN
37402-5017
US

V. Phone/Fax

Practice location:
  • Phone: 423-490-7710
  • Fax: 423-490-7750
Mailing address:
  • Phone: 423-490-7710
  • Fax: 423-490-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number956
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: