Basic Information
| Provider Information | |||||||||
| NPI: | 1578555835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBISON | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | LYNN YU | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 GUNBARREL RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238556800 | ||||||||
| FaxNumber: | 4238551108 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 GUNBARREL RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238556800 | ||||||||
| FaxNumber: | 4238551108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD0000028277 | TN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | TN0104 | 01 | TN | JOHN DEERE PROVIDER NUMBE | OTHER | 0393990001 | 01 | TN | DEMERC PROVIDER NUMBER | OTHER | 180035885 | 01 | TN | RAILROAD MEDICARE NUMBER | OTHER | 1969516 | 01 | TN | CIGNA PROVIDER NUMBER | OTHER | 3830741 | 05 | TN | MEDICAID | 00706131A | 01 | GA | GA MEDICAID NUMBER | OTHER | 3830741 | 01 | TN | MEDICARE | OTHER | 5363147 | 01 | TN | AETNA PROVIDER NUMBER | OTHER | 3709593 | 01 | TN | MEDICARE GROUP NUMBER | OTHER | 3105765 | 01 | TN | BLUE CROSS PROVIDER NUMBE | OTHER |