Healthcare Provider Details

I. General information

NPI: 1619412871
Provider Name (Legal Business Name): TENNESSEE FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 WAYNE RD
SAVANNAH TN
38372
US

IV. Provider business mailing address

PO BOX 1387
SAVANNAH TN
38372-4387
US

V. Phone/Fax

Practice location:
  • Phone: 859-948-7915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number000879494
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE FORSBACH
Title or Position: NURSE PRACTITIONER/OWNER
Credential: FNP-C
Phone: 859-948-7915