Provider Demographics
NPI:1922065556
Name:RELIC, ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RELIC
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 FRANKLIN RD
Mailing Address - Street 2:SUITEW 4B
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3218
Mailing Address - Country:US
Mailing Address - Phone:615-964-6160
Mailing Address - Fax:615-964-6120
Practice Address - Street 1:210 FRANKLIN RD
Practice Address - Street 2:SUITEW 4B
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3218
Practice Address - Country:US
Practice Address - Phone:615-964-6160
Practice Address - Fax:615-964-6120
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA003013L363A00000X
SC1530363A00000X
TN3044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS94639Medicare UPIN