Healthcare Provider Details

I. General information

NPI: 1326061292
Provider Name (Legal Business Name): COPPER BASIN FAMILY PRACTICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MEDICAL CENTER DR BLDG C
COPPERHILL TN
37317-1138
US

IV. Provider business mailing address

PO BOX 1138
COPPERHILL TN
37317-1138
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-1788
  • Fax: 423-496-1776
Mailing address:
  • Phone: 423-496-1788
  • Fax: 423-496-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT JAMES NORRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 423-496-1788