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General NPI Number Information
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NPI Number | 1609075464
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Entity Type | Organization
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Legal Business Name | J. GREGORY ROBERTS, MD, RVT, PC DBA MANTLE CLINIC III
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 10810 PARKSIDE DR STE 309
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City | KNOXVILLE
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State | TN
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Zip | 37934-1986
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Country | US
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Telephone | 865-218-6244
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Fax | 865-218-6245
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Provider Business Mailing Address
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Address Line | 10810 PARKSIDE DR STE 309
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City | KNOXVILLE
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State | TN
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Zip | 37934-1986
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Country | US
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Telephone | 865-218-6244
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Fax | 865-218-6245
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | BARBARA ANN FREELS
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Credential |
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Telephone | 865-218-6244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 37706
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License Number State | TN
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