Healthcare Provider Details

I. General information

NPI: 1336166388
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS OF MONTGOMERY COUNTY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 DUNLOP LN
CLARKSVILLE TN
37040-5015
US

IV. Provider business mailing address

840 CRESCENT CENTRE DR STE 140
FRANKLIN TN
37067-4688
US

V. Phone/Fax

Practice location:
  • Phone: 931-502-1370
  • Fax:
Mailing address:
  • Phone: 615-269-0652
  • Fax: 615-269-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HAROLD W DUKE III
Title or Position: OWNER
Credential: MD
Phone: 615-269-0652