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Organization

J. GREGORY ROBERTS, MD, RVT, PC DBA MANTLE CLINIC III

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BARBARA ANN FREELS (PRACTICE MANAGER)
(865) 218-6244
Entity
Organization

Contact information

Practice address
10810 PARKSIDE DR STE 309, KNOXVILLE, TN 37934-1986
(865) 218-6244
(865) 218-6245
Mailing address
10810 PARKSIDE DR STE 309, KNOXVILLE, TN 37934-1986
(865) 218-6244
(865) 218-6245

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
37706
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4069830
BCBS
05
64078132
KY
01
TN0101
JOHN DEERE HEALTH
TN
Enumeration date
07/12/2007
Last updated
11/16/2010
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