Healthcare Provider Details

I. General information

NPI: 1083909204
Provider Name (Legal Business Name): COMPLETE EXPRESS CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 DINAH SHORE BLVD
WINCHESTER TN
37398-1107
US

IV. Provider business mailing address

1211 DINAH SHORE BLVD
WINCHESTER TN
37398-1107
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-6669
  • Fax: 931-967-6606
Mailing address:
  • Phone: 931-967-6669
  • Fax: 931-967-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. FLOYD DON DAVIS
Title or Position: OWNER
Credential:
Phone: 931-967-6669