Basic Information
| Provider Information | |||||||||
| NPI: | 1720338833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTIAN FAMILY MEDICINE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHRISTIAN FAMILY MEDCINE OF WEAKLEY COUNTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 HIGHWAY 431 | ||||||||
| Address2: | |||||||||
| City: | MARTIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382378264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316358189 | ||||||||
| FaxNumber: | 7316358121 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380634580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316358189 | ||||||||
| FaxNumber: | 7316358182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2012 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7316358189 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHRISTIAN FAMILY MEDICINE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.