Healthcare Provider Details

I. General information

NPI: 1316029663
Provider Name (Legal Business Name): LIFECIRCLE WOMENS HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N OCOEE ST STE A
CLEVELAND TN
37311-3869
US

IV. Provider business mailing address

2301 N OCOEE ST STE A
CLEVELAND TN
37311-3869
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-1400
  • Fax: 423-339-9950
Mailing address:
  • Phone: 423-339-1400
  • Fax: 423-339-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER N. MULLIN
Title or Position: OWNER
Credential: MD
Phone: 423-339-1400