Healthcare Provider Details

I. General information

NPI: 1356537658
Provider Name (Legal Business Name): GREENFIELD MEDICAL CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MERIDIAN ST
GREENFIELD TN
38230-2104
US

IV. Provider business mailing address

801 S MERIDIAN ST
GREENFIELD TN
38230-2104
US

V. Phone/Fax

Practice location:
  • Phone: 731-235-0555
  • Fax: 731-235-0559
Mailing address:
  • Phone: 731-235-0555
  • Fax: 731-235-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number7442
License Number StateTN

VIII. Authorized Official

Name: DONNA KAYE CHIPMAN
Title or Position: OWNER
Credential: FNP
Phone: 731-235-0555