Provider Demographics
NPI:1336367671
Name:CHIN, ROBERT KEVIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KEVIN
Last Name:CHIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:711 COOK DR STE 100
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3499
Practice Address - Country:US
Practice Address - Phone:423-744-7585
Practice Address - Fax:423-746-4993
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I977079Medicare PIN
TNS77380Medicare UPIN