Healthcare Provider Details

I. General information

NPI: 1710920467
Provider Name (Legal Business Name): TIMOTHY MARK FISHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 VO TECH DR SUITE 6
MC MINNVILLE TN
37110-1329
US

IV. Provider business mailing address

140 VO TECH DR SUITE 6
MC MINNVILLE TN
37110-1329
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-4441
  • Fax: 931-473-5031
Mailing address:
  • Phone: 931-473-4441
  • Fax: 931-473-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDO0000000851
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: