Healthcare Provider Details

I. General information

NPI: 1316016660
Provider Name (Legal Business Name): ENGLEWOOD MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W ATHENS ST
ENGLEWOOD TN
37329-3269
US

IV. Provider business mailing address

321 W ATHENS ST PO BOX 232
ENGLEWOOD TN
37329-3269
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-3779
  • Fax: 423-263-3607
Mailing address:
  • Phone: 423-263-3779
  • Fax: 423-263-3607

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: MR. DONALD E DOWNEY
Title or Position: CEO
Credential:
Phone: 423-263-3600