Healthcare Provider Details

I. General information

NPI: 1376898734
Provider Name (Legal Business Name): QUALITY MEDICAL CENTER OF UNION COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 CORRYTON RD
CORRYTON TN
37721-2630
US

IV. Provider business mailing address

PO BOX 316
CORRYTON TN
37721-0316
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3031
  • Fax: 865-992-8103
Mailing address:
  • Phone: 865-992-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000014690
License Number StateTN

VIII. Authorized Official

Name: KRISTI S WALKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-992-3031