Healthcare Provider Details

I. General information

NPI: 1013782499
Provider Name (Legal Business Name): MURFREESBORO MEDICAL CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 SHORED ROAD
MURFREESBORO TN
37127
US

IV. Provider business mailing address

1272 GARRISON DR
MURFREESBORO TN
37129-2598
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-4480
  • Fax:
Mailing address:
  • Phone: 615-893-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER GHARING
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 615-867-7925