Provider Demographics
NPI:1144288747
Name:ROBERTSON, GEORGE WILLIAM II (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:ROBERTSON
Suffix:II
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 1:1407 W BADDOUR PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2513
Mailing Address - Country:US
Mailing Address - Phone:615-444-6203
Mailing Address - Fax:615-444-6252
Practice Address - Street 1:1407 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-444-6203
Practice Address - Fax:615-444-6252
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31453208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7241259OtherCIGNA
TNMD31453OtherLICENSE
TN2118384OtherUHC
TN3844934Medicaid
TN4020554OtherBCBS
TN10810638OtherCAQH
TN020046097OtherMEDIARE RR
TN4020554OtherBCBS
TN3844934Medicare PIN