Provider Demographics
NPI:1710613518
Name:BUTTS, ROBERT IV
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BUTTS
Suffix:IV
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 1:825 IDLEWILD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4746
Mailing Address - Country:US
Mailing Address - Phone:615-294-3220
Mailing Address - Fax:615-294-3220
Practice Address - Street 1:825 IDLEWILD DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4746
Practice Address - Country:US
Practice Address - Phone:615-294-3220
Practice Address - Fax:615-294-3220
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide