Individual
RODNEY SHANE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
398 N MAIN ST, DECATUR, TN 37322-7759
(423) 334-2222
(423) 334-2255
Mailing address
PO BOX 709, DECATUR, TN 37322-0709
(423) 334-2222
(423) 334-2255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
024022
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03718733
—
TN
01
—
0443935
MEDICAID
TN
01
—
443935
RIVERBEND - RURAL HEALTH
TN
Enumeration date
08/09/2005
Last updated
08/17/2012
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