Healthcare Provider Details

I. General information

NPI: 1265822027
Provider Name (Legal Business Name): CLINIC AT SELMER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 FEDERAL DR
SELMER TN
38375-1876
US

IV. Provider business mailing address

714 FEDERAL DR
SELMER TN
38375-1876
US

V. Phone/Fax

Practice location:
  • Phone: 731-645-7952
  • Fax: 731-645-8898
Mailing address:
  • Phone: 731-645-7952
  • Fax: 731-645-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0000015732
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000019130
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000019129
License Number StateTN

VIII. Authorized Official

Name: DR. MOHAMMED SAID BAKEER
Title or Position: OWNER
Credential: M.D.
Phone: 731-645-7952