MEDICARE: CENTER FOR FAMILY PSYCHIATRY PC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3722309	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1679758312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR FAMILY PSYCHIATRY PC

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	:	MD PRESIDENT
Name	:	DR. JOHN B ROBERTSON JR.
Credential	:	MD
Telephone Number	:	865-691-1165

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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