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General NPI Number Information
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NPI Number | 1174602338
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Entity Type | Organization
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Legal Business Name | COLLEGE PARK WALK-IN CLINIC, LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 2104 E ANDREW JOHNSON HWY
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City | MORRISTOWN
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State | TN
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Zip | 37814-5412
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Country | US
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Telephone | 423-318-6093
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Fax | 423-318-6297
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Provider Business Mailing Address
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Address Line | PO BOX 1237
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City | MORRISTOWN
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State | TN
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Zip | 37816-1237
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Country | US
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Telephone | 423-318-6093
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Fax | 423-318-6297
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BETH D YOUNG
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Credential |
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Telephone | 423-318-6093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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