Basic Information
| Provider Information | |||||||||
| NPI: | 1225574056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HH PHYSICIAN CARE-FAYETTEVILLE MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 ELK AVE S | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373343051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314332551 | ||||||||
| FaxNumber: | 9314380069 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 ELK AVE S | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373343051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314332551 | ||||||||
| FaxNumber: | 9314380069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2017 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | CLINTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2562658818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HH HEALTH SYSTEM-TENNESSEE LLC | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10005 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.