Healthcare Provider Details

I. General information

NPI: 1922739119
Provider Name (Legal Business Name): SEYMOUR MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 CHAPMAN HWY STE 6
SEYMOUR TN
37865-4771
US

IV. Provider business mailing address

10721 CHAPMAN HWY STE 6
SEYMOUR TN
37865-4771
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-0471
  • Fax:
Mailing address:
  • Phone: 865-577-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOBBY GRAHAM
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 865-604-5186