Healthcare Provider Details

I. General information

NPI: 1568061661
Provider Name (Legal Business Name): HOMETOWN PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7794 RHEA COUNTY HWY STE 101
DAYTON TN
37321-5981
US

IV. Provider business mailing address

PO BOX 24927
CHATTANOOGA TN
37422-4927
US

V. Phone/Fax

Practice location:
  • Phone: 423-775-3363
  • Fax: 423-775-3366
Mailing address:
  • Phone: 423-643-2576
  • Fax: 423-648-4570

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: JENNIFER LEIGH SHAVER
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 423-775-3363