Basic Information
Provider Information
NPI: 1609118470
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENSLEY
FirstName: ROBIE
MiddleName: THEODORE
NamePrefix: DR.
NameSuffix: III
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1225 E WEISGARBER RD
Address2: SUITE 200
City: KNOXVILLE
State: TN
PostalCode: 379092604
CountryCode: US
TelephoneNumber: 8655844747
FaxNumber: 8655841363
Practice Location
Address1: 1404 TUSCULUM BLVD
Address2: SUITE 3100
City: GREENEVILLE
State: TN
PostalCode: 377454395
CountryCode: US
TelephoneNumber: 4236384114
FaxNumber: 4236381605
Other Information
ProviderEnumerationDate: 03/20/2013
LastUpdateDate: 11/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X52504TNY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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