Healthcare Provider Details

I. General information

NPI: 1023257391
Provider Name (Legal Business Name): JRT MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HUNTERS LANE SUITE 100
TULLAHOMA TN
37388-0000
US

IV. Provider business mailing address

100 HUNTERS LANE SUITE 100
TULLAHOMA TN
37388-0000
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-4616
  • Fax: 931-455-2362
Mailing address:
  • Phone: 931-455-4616
  • Fax: 931-455-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD11581
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13534
License Number StateTN

VIII. Authorized Official

Name: DR. JOSEPH RICHARD THOMASSON JR.
Title or Position: PHYSICAN/OWNER
Credential: M.D.
Phone: 931-455-4616