Healthcare Provider Details

I. General information

NPI: 1801177449
Provider Name (Legal Business Name): MCMINN ORTOPAEDIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 COOK DR STE 110
ATHENS TN
37303-3495
US

IV. Provider business mailing address

PO BOX 688
ATHENS TN
37371-0688
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-2344
  • Fax: 423-745-2314
Mailing address:
  • Phone: 423-745-2344
  • Fax: 423-745-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberDO01701
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID R ROBINS
Title or Position: OWNER
Credential: D.O.
Phone: 423-745-2344