Healthcare Provider Details

I. General information

NPI: 1912496274
Provider Name (Legal Business Name): COMMUNITY CENTER HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 PARKWAY STE 202
SEVIERVILLE TN
37862-4020
US

IV. Provider business mailing address

190 COMMUNITY CENTER DR STE 102
PIGEON FORGE TN
37863-6243
US

V. Phone/Fax

Practice location:
  • Phone: 865-446-4032
  • Fax: 865-868-4746
Mailing address:
  • Phone: 865-446-4032
  • Fax: 865-868-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55849
License Number StateTN

VIII. Authorized Official

Name: RHONDA DEE DAVIS
Title or Position: GENERAL MANAGER
Credential:
Phone: 865-446-4032