Healthcare Provider Details

I. General information

NPI: 1841614005
Provider Name (Legal Business Name): PREMIER PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EDWARDS ST
UNION CITY TN
38261-5320
US

IV. Provider business mailing address

1208 EDWARDS ST
UNION CITY TN
38261-5320
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-8884
  • Fax:
Mailing address:
  • Phone: 731-885-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18135
License Number StateTN

VIII. Authorized Official

Name: TINA WRIGHT
Title or Position: OFFICE MANAGER
Credential:
Phone: 731-885-8884