Healthcare Provider Details

I. General information

NPI: 1376961979
Provider Name (Legal Business Name): FIRST MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E PARKWAY
GATLINBURG TN
37738-5057
US

IV. Provider business mailing address

1015 E PARKWAY
GATLINBURG TN
37738-5057
US

V. Phone/Fax

Practice location:
  • Phone: 865-446-4032
  • Fax: 865-868-4746
Mailing address:
  • Phone: 865-446-4032
  • Fax: 865-868-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number914
License Number StateTN

VIII. Authorized Official

Name: DR. ROBERT M MAUGHON
Title or Position: OWNER
Credential: M.D.
Phone: 865-446-4032