Healthcare Provider Details

I. General information

NPI: 1740635440
Provider Name (Legal Business Name): JOHN R. ROBERTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2016
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 W JAMES M CAMPBELL BLVD STE 403
COLUMBIA TN
38401-4659
US

IV. Provider business mailing address

854 W JAMES M CAMPBELL BLVD STE 303
COLUMBIA TN
38401-4672
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-0075
  • Fax: 931-388-7502
Mailing address:
  • Phone: 931-380-0075
  • Fax: 931-388-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3380
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: