Healthcare Provider Details

I. General information

NPI: 1639376353
Provider Name (Legal Business Name): STONECREST MEDICAL GROUP - FAMILY PRACTICE OF MURFREESBORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 11/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 OLD FORT PARKWAY SUITE E
MURFREESBORO TN
37128
US

IV. Provider business mailing address

2706 OLD FORT PARKWAY SUITE E
MURFREESBORO TN
37128
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-1230
  • Fax: 615-893-1232
Mailing address:
  • Phone: 615-893-1230
  • Fax: 615-893-1232

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: CHUCK LOCKE
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-373-7604