Basic Information
| Provider Information | |||||||||
| NPI: | 1942375571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED FAMILY AND URGENT CARE CLINIC,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1118 | ||||||||
| Address2: | 4114 THORNTON TAYLOR PKWY | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373341118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314388260 | ||||||||
| FaxNumber: | 9314388257 | ||||||||
| Practice Location | |||||||||
| Address1: | 4114 THORNTON TAYLOR PKWY | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373342662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314388260 | ||||||||
| FaxNumber: | 9314388257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 9314388260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5968 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.