MEDICARE: JOHN BURR ROBERTSON JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD0000021455	TN
2	2084P0802X	Addiction Psychiatry Physician	MD0000021455	TN
3	2084P0804X	Child & Adolescent Psychiatry Physician	MD0000021455	TN

General Provider Information

NPI Number	:	1407840481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BURR ROBERTSON JR. MD

Provider Business Mailing Address
First Line	:	10241 KINGSTON PIKE
Second Line	:	SUITE 1 AND 2
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3240
Country	:	US
Telephone Number	:	865-691-1165
Fax Number	:	865-690-6042

Provider Business Practice Location Address
First Line	:	10241 KINGSTON PIKE
Second Line	:	SUITE 1 AND 2
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3240
Country	:	US
Telephone Number	:	865-691-1165
Fax Number	:	865-690-6042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	09/11/2025

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