Basic Information
| Provider Information | |||||||||
| NPI: | 1194896597 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRISTOL GYNECOLOGY & OBSTETRICS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 MIDWAY MEDICAL PARK STE 101 | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376201693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239683033 | ||||||||
| FaxNumber: | 4239683789 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 MIDWAY MEDICAL PARK STE 101 | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376201693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239683033 | ||||||||
| FaxNumber: | 4239683789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4239683033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D.,FACOG | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.