Healthcare Provider Details

I. General information

NPI: 1235114893
Provider Name (Legal Business Name): CARL M ORQUIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 MOUNTAIN VIEW ROAD SUITE 109
OOLTEWAH TN
37363-6685
US

IV. Provider business mailing address

6401 MOUNTAIN VIEW RD SUITE 109
OOLTEWAH TN
37363-6685
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-5951
  • Fax: 423-495-5999
Mailing address:
  • Phone: 423-495-5951
  • Fax: 423-495-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31253
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: