Healthcare Provider Details

I. General information

NPI: 1912922261
Provider Name (Legal Business Name): ROBERT B HUGHES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 REDBUSH CT STE 2
JOHNSON CITY TN
37601-4340
US

IV. Provider business mailing address

2 REDBUSH CT STE 2
JOHNSON CITY TN
37601-4340
US

V. Phone/Fax

Practice location:
  • Phone: 423-952-0992
  • Fax: 423-283-7135
Mailing address:
  • Phone: 423-952-0992
  • Fax: 423-283-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1897
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: