Healthcare Provider Details

I. General information

NPI: 1194923029
Provider Name (Legal Business Name): LOBELVILLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 NORTH MAIN ST
LOBELVILLE TN
37097
US

IV. Provider business mailing address

PO BOX 219 236 NORTH MAIN ST.
LOBELVILLE TN
37097-0219
US

V. Phone/Fax

Practice location:
  • Phone: 931-593-2277
  • Fax: 931-593-2517
Mailing address:
  • Phone: 931-593-2277
  • Fax: 931-593-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BECKY S CUNNINGHAM
Title or Position: OFFICE MGR.
Credential: OFFICE MGR.
Phone: 931-593-2277