Provider Demographics
NPI:1386745529
Name:ROBERSON, ANTHONY JAMES (PHD, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PETER BRYCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7456
Mailing Address - Country:US
Mailing Address - Phone:205-348-6262
Mailing Address - Fax:205-348-4121
Practice Address - Street 1:750 PETER BRYCE BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7456
Practice Address - Country:US
Practice Address - Phone:205-348-6262
Practice Address - Fax:205-348-4121
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC186811163W00000X
FL9365822363LP0808X
NC950018363LP0808X
AL11139092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC825072000OtherMAGELLAN
NC2041002OtherCIGNA
NCNCMC034223OtherNC HEALTHCHOICE VALUE OPT
NC6005012Medicaid