Healthcare Provider Details

I. General information

NPI: 1336806900
Provider Name (Legal Business Name): CIRCLE H CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S MAIN ST
SWEETWATER TN
37874-2705
US

IV. Provider business mailing address

510 S MAIN ST
SWEETWATER TN
37874-2705
US

V. Phone/Fax

Practice location:
  • Phone: 423-337-7933
  • Fax: 423-337-2806
Mailing address:
  • Phone: 423-337-7933
  • Fax: 423-337-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENT E HICKEY
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: PHARMD
Phone: 423-210-0695