Healthcare Provider Details

I. General information

NPI: 1417941675
Provider Name (Legal Business Name): ROBERT DAVID GILLESPIE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 JOY ST
PARIS TN
38242-4540
US

IV. Provider business mailing address

808 JOY ST
PARIS TN
38242-4540
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-0800
  • Fax: 731-642-0818
Mailing address:
  • Phone: 731-642-0800
  • Fax: 731-642-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0000001064
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: