Provider Demographics
NPI:1154596914
Name:ROBERTS, JILL BETHANY (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:BETHANY
Last Name:ROBERTS
Suffix:
Gender:F
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:P.O. BOX 11407
Mailing Address - Street 2:DEPT# 2069
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2069
Mailing Address - Country:US
Mailing Address - Phone:256-840-4571
Mailing Address - Fax:256-840-4534
Practice Address - Street 1:2367 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5910
Practice Address - Country:US
Practice Address - Phone:256-840-4571
Practice Address - Fax:256-840-4534
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.2896R207Q00000X
AL30193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine