Healthcare Provider Details

I. General information

NPI: 1073940938
Provider Name (Legal Business Name): FAMILY MEDICAL THERAPIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 AULT RD STE B
SIGNAL MOUNTAIN TN
37377-3126
US

IV. Provider business mailing address

6 ROCK CREST DR
SIGNAL MOUNTAIN TN
37377-2302
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-5404
  • Fax: 706-406-2922
Mailing address:
  • Phone: 423-521-5404
  • Fax: 706-406-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PAUL A MIRANDA
Title or Position: SOLE OWNER
Credential: MD
Phone: 423-521-5404