Provider Demographics
NPI:1982698627
Name:MAXWELL, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-778-8168
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-778-8168
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29718208600000X, 2086S0102X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910780Medicaid
OH2536536Medicaid
TN3829392Medicaid
NC790608UMedicaid
GA00859097BMedicaid
020042396OtherRR MEDICARE
3125384OtherBCBS OF TN
62165877440OtherJDH
6333337 002OtherCIGNA
1740398OtherUHC
020042396OtherRR MEDICARE
NC790608UMedicaid