Healthcare Provider Details

I. General information

NPI: 1801892609
Provider Name (Legal Business Name): PRIMARY CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 DEVONIA ST
HARRIMAN TN
37748-2010
US

IV. Provider business mailing address

413 DEVONIA ST
HARRIMAN TN
37748-2010
US

V. Phone/Fax

Practice location:
  • Phone: 865-882-3211
  • Fax: 865-882-9889
Mailing address:
  • Phone: 865-882-3211
  • Fax: 865-882-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD005463
License Number StateTN

VIII. Authorized Official

Name: MRS. KIM ZIEGLER WALLS
Title or Position: OFFICE MANAGER
Credential: RHIT
Phone: 865-882-3211