Organization
R. SHANE ROBERTS, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
R. SHANE ROBERTS M.D. (OWNER)
(423) 334-2222
Entity
Organization
Contact information
Practice address
398 N MAIN ST, DECATUR, TN 37322-7759
(423) 334-2222
(423) 334-2255
Mailing address
398 N MAIN ST, DECATUR, TN 37322-7759
(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
—
0443935
—
TN
05
—
3718733
—
TN
Enumeration date
06/22/2007
Last updated
03/10/2022
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