Basic Information
| Provider Information | |||||||||
| NPI: | 1740635440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 W JAMES M CAMPBELL BLVD STE 303 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315404255 | ||||||||
| FaxNumber: | 9314904654 | ||||||||
| Practice Location | |||||||||
| Address1: | 1114 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384011810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313889706 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2016 | ||||||||
| LastUpdateDate: | 07/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3380 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.