Provider Demographics
NPI:1417082710
Name:HIATT, ROGER LEW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEW
Last Name:HIATT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10047 BUSHROD CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9188
Mailing Address - Country:US
Mailing Address - Phone:801-200-5050
Mailing Address - Fax:870-394-7111
Practice Address - Street 1:600 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3235
Practice Address - Country:US
Practice Address - Phone:870-394-7100
Practice Address - Fax:870-394-7111
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARN-83812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130272001Medicaid
ARF-70831Medicare UPIN