Healthcare Provider Details

I. General information

NPI: 1518553247
Provider Name (Legal Business Name): ACCESS MEDICAL CLINIC TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CONCORD RD STE 100
FARRAGUT TN
37934-2941
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 865-888-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax: 870-856-2107

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: MONYA YORK
Title or Position: COMPTROLLER
Credential:
Phone: 870-856-1202