=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033914767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY DIRECT PRIMARY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2850 WESTSIDE DR NW STE A2
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37312-3503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-564-8018
-----------------------------------------------------
Fax | 423-674-3474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2850 WESTSIDE DR NW STE A2
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37312-3503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-564-8018
-----------------------------------------------------
Fax | 423-674-3474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | BRITTANY DAWN MILLICAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-897-8671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------