Healthcare Provider Details

I. General information

NPI: 1174749469
Provider Name (Legal Business Name): FRIX-JENNINGS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W MAIN ST
HENDERSON TN
38340-2231
US

IV. Provider business mailing address

116 W MAIN ST
HENDERSON TN
38340-2231
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-0001
  • Fax: 731-989-5151
Mailing address:
  • Phone: 731-989-0001
  • Fax: 731-989-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34836
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34823
License Number StateTN

VIII. Authorized Official

Name: CAREY WALLACE FRIX
Title or Position: PRESIDENT
Credential: MD
Phone: 731-989-0001