Provider Demographics
NPI:1962480467
Name:ROBERSON, CLIFFORD FULTON (MD)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:FULTON
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 25TH AVE N STE 300A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1632
Mailing Address - Country:US
Mailing Address - Phone:615-342-4480
Mailing Address - Fax:615-342-4489
Practice Address - Street 1:250 25TH AVE N STE 300A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1632
Practice Address - Country:US
Practice Address - Phone:615-342-4480
Practice Address - Fax:615-342-4489
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0142972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA97927Medicare UPIN
TN3822952Medicare ID - Type Unspecified