Healthcare Provider Details

I. General information

NPI: 1437194263
Provider Name (Legal Business Name): MEDICAL GROUP - STONECREST FP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONECREST BLVD SUITE 100
SMYRNA TN
37167-5688
US

IV. Provider business mailing address

300 STONECREST BLVD SUITE 100
SMYRNA TN
37167-5688
US

V. Phone/Fax

Practice location:
  • Phone: 615-223-9502
  • Fax: 615-223-9596
Mailing address:
  • Phone: 615-223-9502
  • Fax: 615-223-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHUCK LOCKE
Title or Position: VP
Credential:
Phone: 615-373-7604