Healthcare Provider Details

I. General information

NPI: 1912089145
Provider Name (Legal Business Name): JAMES W. SEGO,DO, INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 STUART RD NE STE 106
CLEVELAND TN
37312-5858
US

IV. Provider business mailing address

PO BOX 290
GEORGETOWN TN
37336-0290
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-5915
  • Fax: 423-478-5316
Mailing address:
  • Phone: 423-472-5915
  • Fax: 423-478-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W SEGO
Title or Position: OWNER
Credential: DO
Phone: 423-472-5915