Provider Demographics
NPI:1699015743
Name:PERRY, ROBERT CALVIN JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CALVIN
Last Name:PERRY
Suffix:JR
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:PO BOX 5645
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5645
Mailing Address - Country:US
Mailing Address - Phone:423-631-0141
Mailing Address - Fax:423-631-0157
Practice Address - Street 1:2408 SUSANNAH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1748
Practice Address - Country:US
Practice Address - Phone:423-631-0141
Practice Address - Fax:423-631-0157
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional