Healthcare Provider Details

I. General information

NPI: 1225092547
Provider Name (Legal Business Name): HOHENWALD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S PARK ST
HOHENWALD TN
38462-1413
US

IV. Provider business mailing address

PO BOX 5
HOHENWALD TN
38462-0005
US

V. Phone/Fax

Practice location:
  • Phone: 931-796-7960
  • Fax: 931-796-7790
Mailing address:
  • Phone: 931-796-7960
  • Fax: 931-796-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0000000781
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000021337
License Number StateTN

VIII. Authorized Official

Name: MICHAEL PARKER
Title or Position: PARTNER
Credential:
Phone: 931-796-7960