Healthcare Provider Details

I. General information

NPI: 1619904570
Provider Name (Legal Business Name): UNAKA INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LOVE ST
ERWIN TN
37650
US

IV. Provider business mailing address

500 LOVE STREET
ERWIN TN
37650
US

V. Phone/Fax

Practice location:
  • Phone: 423-735-4160
  • Fax: 423-735-4159
Mailing address:
  • Phone: 423-735-4160
  • Fax: 423-735-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO0000001740
License Number StateTN

VIII. Authorized Official

Name: DR. CHARLES G MILLER II
Title or Position: PHYSICIAN/PRESIDENT
Credential: DO
Phone: 423-735-4160