Healthcare Provider Details

I. General information

NPI: 1730457649
Provider Name (Legal Business Name): TULLAHOMA IMMEDIATE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S JACKSON ST
TULLAHOMA TN
37388-4386
US

IV. Provider business mailing address

100 WILLIAM NORTHERN BLVD
TULLAHOMA TN
37388-4754
US

V. Phone/Fax

Practice location:
  • Phone: 931-454-0489
  • Fax: 931-454-1227
Mailing address:
  • Phone: 931-454-0489
  • Fax: 931-454-1227

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: DR. JOHN D PATSIMAS
Title or Position: M.D.
Credential: M.D.
Phone: 931-454-0489