Healthcare Provider Details

I. General information

NPI: 1427449602
Provider Name (Legal Business Name): PRIMARY CARE & GERIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 W MORRIS BLVD STE C
MORRISTOWN TN
37813-2969
US

IV. Provider business mailing address

1621 W MORRIS BLVD STE C
MORRISTOWN TN
37813-2969
US

V. Phone/Fax

Practice location:
  • Phone: 423-317-7412
  • Fax: 423-317-7415
Mailing address:
  • Phone: 423-317-7412
  • Fax: 423-317-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAPN00000019620
License Number StateTN

VIII. Authorized Official

Name: DR. RAJEEV GUPTA
Title or Position: OWNER
Credential: MD
Phone: 423-317-7412