Healthcare Provider Details

I. General information

NPI: 1255673380
Provider Name (Legal Business Name): DOWNTOWN MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOPKINS AVENUE
BELLS TN
38006
US

IV. Provider business mailing address

113 HOPKINS AVENUE
BELLS TN
38006
US

V. Phone/Fax

Practice location:
  • Phone: 731-663-0951
  • Fax: 731-663-0941
Mailing address:
  • Phone: 731-663-0951
  • Fax: 731-663-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberAP0005413
License Number StateTN

VIII. Authorized Official

Name: MS. MARY N BOND
Title or Position: NURSE PRACTIONER
Credential: FNP
Phone: 731-663-0951