| Organization Name: | ROBERTSON COUNTY PHYSICAL MEDICINE LLC |
| NPI Number: | 1790045060 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRIS JACKSON (OWNER) |
| Mailing Address: | 2308d Memorial Blvd Springfield |
| State: | TN US |
| Postal Code: | 371723929 |
| Phone Number: | 6153828144 |
| Fax Number: | 6153828145 |
| NPI Enumeration Date: | 05/21/2012 |
| NPI Last Update Date: | 06/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD0000027058 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |