Healthcare Provider Details

I. General information

NPI: 1114071396
Provider Name (Legal Business Name): FAMILY HEALTHCARE ASSOCIATES OF GREENBRIER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 HIGHWAY 41 S
GREENBRIER TN
37073-5516
US

IV. Provider business mailing address

2557 HIGHWAY 41 S
GREENBRIER TN
37073-5516
US

V. Phone/Fax

Practice location:
  • Phone: 615-643-4534
  • Fax: 615-643-4537
Mailing address:
  • Phone: 615-643-4534
  • Fax: 615-643-4537

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: DAVID P SPARKS
Title or Position: MD
Credential: MD
Phone: 615-643-4534