Provider Demographics
NPI:1013900943
Name:ROBERTS, ANDY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:A
Last Name:ROBERTS
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:
Practice Address - Street 1:109 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5603
Practice Address - Country:US
Practice Address - Phone:423-638-4131
Practice Address - Fax:423-638-9239
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3005285OtherBC BS TN
TN3089112Medicaid
TN7OtherJOHN DEERE
TN3005285OtherBLUE CARE
00006415OtherNHC HEALTH BENEFITS
E46224Medicare UPIN
TN3089112Medicare ID - Type UnspecifiedMEDICARE