Healthcare Provider Details

I. General information

NPI: 1326228602
Provider Name (Legal Business Name): ROBERT STETSON, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 EXECUTIVE PARK NW SUITE #3
CLEVELAND TN
37312-2746
US

IV. Provider business mailing address

2650 EXECUTIVE PARK NW SUITE #3
CLEVELAND TN
37312-2746
US

V. Phone/Fax

Practice location:
  • Phone: 423-473-2633
  • Fax: 423-473-2643
Mailing address:
  • Phone: 423-473-2633
  • Fax: 423-473-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number42758
License Number StateTN

VIII. Authorized Official

Name: DR. ROBERT ALLAN STETSON JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-473-2633