Organization
J. GREGORY ROBERTS MD RVT
Active
Other names
Mantle Clinic III
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES GREGORY ROBERTS MD RVT FACS (PHYSICIAN)
(865) 218-6244
Entity
Organization
Contact information
Practice address
10810 PARKSIDE DR, SUITE 309, KNOXVILLE, TN 37934-1979
(865) 218-6244
(865) 218-6245
Mailing address
1728 FALCON POINTE DR, KNOXVILLE, TN 37922-6397
(865) 438-0096
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
37706
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY NUMBER
TN
01
—
4069830
BCBS
TN
01
—
64078132
KENTUCKY MEDICAID
KY
01
—
DA9327
RAILROAD MEDICARE
TN
Enumeration date
02/20/2007
Last updated
05/21/2020
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