Healthcare Provider Details

I. General information

NPI: 1306853965
Provider Name (Legal Business Name): PRIMARY CARE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SHAVER DR
TALBOTT TN
37877-8552
US

IV. Provider business mailing address

204 SHAVER DR
TALBOTT TN
37877-8552
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-7040
  • Fax: 423-581-9563
Mailing address:
  • Phone: 423-581-7040
  • Fax: 423-581-9563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015927
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000017666
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000029081
License Number StateTN

VIII. Authorized Official

Name: DR. REGINA NEPOMUCENO COLEMAN
Title or Position: OWNER
Credential: MD
Phone: 423-581-7040