Healthcare Provider Details

I. General information

NPI: 1194431502
Provider Name (Legal Business Name): FAMILY CHRISTIAN CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CHAMBLISS AVE NW
CLEVELAND TN
37311-3874
US

IV. Provider business mailing address

2200 CHAMBLISS AVE NW
CLEVELAND TN
37311-3874
US

V. Phone/Fax

Practice location:
  • Phone: 423-599-9347
  • Fax:
Mailing address:
  • Phone: 423-599-9347
  • Fax: 866-369-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER D WALKER
Title or Position: OWNER-PHYSICIAN ASSISTANT
Credential: DMSC, PA-C
Phone: 423-599-9347