Provider Demographics
NPI:1225569221
Name:ROBERTS, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 AMNICOLA HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-3603
Mailing Address - Country:US
Mailing Address - Phone:423-698-8971
Mailing Address - Fax:423-624-5160
Practice Address - Street 1:2710 AMNICOLA HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3603
Practice Address - Country:US
Practice Address - Phone:423-698-8971
Practice Address - Fax:423-624-5160
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO0000000031224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist