Healthcare Provider Details

I. General information

NPI: 1932790128
Provider Name (Legal Business Name): EMERALD PRIMARY CARE AND WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NEEDHAM DR
SMYRNA TN
37167-9403
US

IV. Provider business mailing address

1130 BRITANNIA WAY
MURFREESBORO TN
37129-3791
US

V. Phone/Fax

Practice location:
  • Phone: 601-672-9730
  • Fax:
Mailing address:
  • Phone: 601-672-9730
  • Fax:

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: CENTERIA GREEN WOOLFOLK
Title or Position: OWNER/ FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 601-672-9730