Healthcare Provider Details

I. General information

NPI: 1528077013
Provider Name (Legal Business Name): EDWIN DALE SCHOONOVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 MEMORIAL DR SUITE 110
CLARKSVILLE TN
37043-4523
US

IV. Provider business mailing address

501 DAWSON RD
CUMBERLAND FURNACE TN
37051-9001
US

V. Phone/Fax

Practice location:
  • Phone: 931-221-2179
  • Fax: 931-221-2173
Mailing address:
  • Phone: 931-387-3730
  • Fax: 931-387-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD17602
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: