Provider Demographics
NPI:1023248994
Name:HIGGINBOTTOM, ROBERT EDWARD (DPH)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:HIGGINBOTTOM
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765B FLORENCE RD # RS
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-3101
Mailing Address - Country:US
Mailing Address - Phone:731-925-3956
Mailing Address - Fax:731-925-8754
Practice Address - Street 1:765B FLORENCE RD # RS
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3101
Practice Address - Country:US
Practice Address - Phone:731-925-3956
Practice Address - Fax:731-925-8754
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02769183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023248994OtherNPI
045633001Medicare UPIN