Healthcare Provider Details

I. General information

NPI: 1154509693
Provider Name (Legal Business Name): LEWISBURG MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E COMMERCE ST
LEWISBURG TN
37091-3340
US

IV. Provider business mailing address

122 E COMMERCE ST
LEWISBURG TN
37091-3340
US

V. Phone/Fax

Practice location:
  • Phone: 931-270-7888
  • Fax: 931-270-7882
Mailing address:
  • Phone: 931-270-7888
  • Fax: 931-270-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. EDITH ANN WILES
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-270-7888