Healthcare Provider Details

I. General information

NPI: 1952719601
Provider Name (Legal Business Name): FIRST MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 COMMUNITY CENTER DR SUITE 102
PIGEON FORGE TN
37863-6251
US

IV. Provider business mailing address

1229 N EASTMAN RD SUITE 210
KINGSPORT TN
37664-3166
US

V. Phone/Fax

Practice location:
  • Phone: 865-446-4032
  • Fax: 865-868-4746
Mailing address:
  • Phone: 423-765-2243
  • Fax: 423-765-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD16795
License Number StateTN

VIII. Authorized Official

Name: DR. ROBERT M MAUGHON
Title or Position: OWNER
Credential: M.D.
Phone: 865-446-4032