Healthcare Provider Details

I. General information

NPI: 1952561979
Provider Name (Legal Business Name): WARTRACE FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 BLACKMAN BLVD W
WARTRACE TN
37183-2210
US

IV. Provider business mailing address

1612 N MAIN ST SUITE B
SHELBYVILLE TN
37160-2391
US

V. Phone/Fax

Practice location:
  • Phone: 931-389-0600
  • Fax: 931-389-6781
Mailing address:
  • Phone: 931-685-2022
  • Fax: 931-685-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000029483
License Number StateTN

VIII. Authorized Official

Name: MR. RODNEY C PARSONS
Title or Position: OWNER
Credential:
Phone: 931-685-2022