Provider Demographics
NPI:1679758312
Name:CENTER FOR FAMILY PSYCHIATRY PC
Entity Type:Organization
Organization Name:CENTER FOR FAMILY PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:865-691-1165
Mailing Address - Street 1:10241 KINGSTON PIKE
Mailing Address - Street 2:SUITE 1 AND 2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3240
Mailing Address - Country:US
Mailing Address - Phone:865-691-1165
Mailing Address - Fax:865-690-6042
Practice Address - Street 1:10241 KINGSTON PIKE
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3240
Practice Address - Country:US
Practice Address - Phone:865-691-1165
Practice Address - Fax:865-690-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3722309OtherMEDICARE PTAN