=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144653155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOE R FITE MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2013
-----------------------------------------------------
Last Update Date | 08/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1218 TROTWOOD AVE
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38401-6406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-490-7440
-----------------------------------------------------
Fax | 931-540-4143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1218 TROTWOOD AVE
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38401-6406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-490-7440
-----------------------------------------------------
Fax | 931-540-4143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. JOE R FITE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 931-490-7440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 14345
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------