Basic Information
| Provider Information | |||||||||
| NPI: | 1376682021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY MEDICINE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 WESTSIDE DR NW | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373123699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234721511 | ||||||||
| FaxNumber: | 4234799202 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 WESTSIDE DR NW | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373123699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234721511 | ||||||||
| FaxNumber: | 4234799202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHASTAIN | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4234721511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 207QA0505X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.