Healthcare Provider Details

I. General information

NPI: 1730344060
Provider Name (Legal Business Name): MEDICAL ASSOCIATES DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MCMINNVILLE HWY
MANCHESTER TN
37355-3179
US

IV. Provider business mailing address

1615 MCMINNVILLE HWY
MANCHESTER TN
37355-3179
US

V. Phone/Fax

Practice location:
  • Phone: 931-728-6205
  • Fax: 931-723-3194
Mailing address:
  • Phone: 931-728-6205
  • Fax: 931-723-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO738
License Number StateTN

VIII. Authorized Official

Name: ROBERT J COUCH
Title or Position: CEO
Credential:
Phone: 931-728-6354