Healthcare Provider Details

I. General information

NPI: 1336146547
Provider Name (Legal Business Name): JOSEPH EDWARD BIEBERLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ONEEGA LN STE A
ERWIN TN
37650-2199
US

IV. Provider business mailing address

630 ONEEGA LN STE A
ERWIN TN
37650-2199
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-4777
  • Fax: 423-743-3215
Mailing address:
  • Phone: 423-743-4777
  • Fax: 423-743-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12505
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: