Healthcare Provider Details

I. General information

NPI: 1376682021
Provider Name (Legal Business Name): FAMILY MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTSIDE DR NW SUITE 103
CLEVELAND TN
37312-3699
US

IV. Provider business mailing address

2700 WESTSIDE DR NW SUITE 103
CLEVELAND TN
37312-3699
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-1511
  • Fax: 423-479-9202
Mailing address:
  • Phone: 423-472-1511
  • Fax: 423-479-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN C CHASTAIN
Title or Position: PARTNER
Credential: M.D.
Phone: 423-472-1511