Healthcare Provider Details

I. General information

NPI: 1194551358
Provider Name (Legal Business Name): FULL ACCESS MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16850 STATE HIGHWAY 58 S STE D3
DECATUR TN
37322-5259
US

IV. Provider business mailing address

16850 STATE HIGHWAY 58 S STE D3
DECATUR TN
37322-5259
US

V. Phone/Fax

Practice location:
  • Phone: 423-506-0140
  • Fax:
Mailing address:
  • Phone: 423-506-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ENGLISH PAIGE ROBERTS
Title or Position: OWNER
Credential: FNP
Phone: 423-506-3781