Healthcare Provider Details

I. General information

NPI: 1932308590
Provider Name (Legal Business Name): FAMILY PRACTICE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E REELFOOT AVE SUITE 202A
UNION CITY TN
38261-6047
US

IV. Provider business mailing address

1720 E REELFOOT AVE SUITE 202A
UNION CITY TN
38261-6047
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-3866
  • Fax: 731-536-1090
Mailing address:
  • Phone: 731-885-3866
  • Fax: 731-536-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA E MCGRATH
Title or Position: FNP
Credential:
Phone: 731-885-3866