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General NPI Number Information
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NPI Number | 1013048792
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 619 MAIN ST N
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City | CARTHAGE
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State | TN
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Zip | 37030-1259
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Country | US
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Telephone | 615-735-8040
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Fax | 615-735-8048
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Provider Business Mailing Address
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Address Line | 619 MAIN ST N
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City | CARTHAGE
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State | TN
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Zip | 37030-1259
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Country | US
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Telephone | 615-735-8040
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Fax | 615-735-8048
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Authorized Official
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Title or Position | NP, PRESIDENT
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Name | NIKKI ADAMS
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Credential |
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Telephone | 615-735-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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