Healthcare Provider Details

I. General information

NPI: 1639482292
Provider Name (Legal Business Name): CENTERS FOR FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 OLD HICKORY BLVD SUITE 201
HERMITAGE TN
37076-2589
US

IV. Provider business mailing address

5114 OLD HICKORY BLVD SUITE 201
HERMITAGE TN
37076-2589
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-6080
  • Fax: 615-884-0370
Mailing address:
  • Phone: 615-889-6080
  • Fax: 615-884-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBM7363447
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM230
License Number StateTN

VIII. Authorized Official

Name: MRS. JOYCE A HILT
Title or Position: SECRETARY
Credential:
Phone: 615-889-6080