Healthcare Provider Details

I. General information

NPI: 1366607277
Provider Name (Legal Business Name): POLYCLINICS.NET, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 BRYAN DR
DAYTON TN
37321-6275
US

IV. Provider business mailing address

PO BOX 189
SODDY DAISY TN
37384-0189
US

V. Phone/Fax

Practice location:
  • Phone: 423-285-1690
  • Fax: 423-285-1691
Mailing address:
  • Phone: 423-285-1690
  • Fax: 423-285-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberN/A
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberN/A
License Number StateTN

VIII. Authorized Official

Name: DAVID M JENKINSON
Title or Position: MEDICAL DIRECTOR / OWNER
Credential: DO
Phone: 423-285-1690