Healthcare Provider Details

I. General information

NPI: 1720490048
Provider Name (Legal Business Name): WOMEN'S HEALTH CENTER & PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 TAZEWELL RD STE 202
TAZEWELL TN
37879-3600
US

IV. Provider business mailing address

1610 TAZEWELL RD STE 202
TAZEWELL TN
37879-3600
US

V. Phone/Fax

Practice location:
  • Phone: 423-626-2410
  • Fax:
Mailing address:
  • Phone: 423-626-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO1498
License Number StateTN

VIII. Authorized Official

Name: SCOTT MATSON
Title or Position: OWNER
Credential: D.O.
Phone: 423-626-2410