Healthcare Provider Details

I. General information

NPI: 1679583801
Provider Name (Legal Business Name): CLEARWATER INVESTMENTS INC BYRDSTOWN MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/11/2024
Certification Date: 02/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HWY 111
BYRDSTOWN TN
38549-1006
US

IV. Provider business mailing address

8401 HWY 111
BYRDSTOWN TN
38549-1006
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-3187
  • Fax: 931-864-7102
Mailing address:
  • Phone: 931-864-3187
  • Fax: 931-864-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEEDEE JOHNSON
Title or Position: CREDENTIALING / SYSTEMS ADMIN
Credential:
Phone: 931-864-3187