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 (PHYSICIAN)
(865) 218-6244
Entity
Organization
Contact information
Practice address
223 ANDREW DR, ONEIDA, TN 37841
(865) 218-6244
(865) 218-6245
Mailing address
1728 FALCON POINTE DR, KNOXVILLE, TN 37922-6397
(865) 742-3063
(865) 218-6244
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
—
64078132
KENTUCKY MEDICAID
TN
01
—
BCBS
4069830
TN
01
—
RAILROAD MEDICARE
RAILROAD MEDICARE
TN
Enumeration date
02/22/2007
Last updated
08/22/2020
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