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General NPI Number Information
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NPI Number | 1174691794
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Entity Type | Organization
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Legal Business Name | MICHAEL MOFFATT
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 915 CLINGAN RIDGE DR. NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3729
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Country | US
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Telephone | 423-339-3340
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Fax | 423-339-9927
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Provider Business Mailing Address
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Address Line | 915 CLINGAN RIDGE DR. NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3729
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Country | US
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Telephone | 423-339-3340
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Fax | 423-339-9927
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL J MOFFATT
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Credential | D.O.
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Telephone | 423-339-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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