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General NPI Number Information
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NPI Number | 1235315946
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Entity Type | Organization
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Legal Business Name | DR. DAVID G. FLORENCE
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 804 KEYLON ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2414
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Country | US
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Telephone | 931-728-5522
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Fax | 931-728-2247
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Provider Business Mailing Address
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Address Line | PO BOX 749
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City | MANCHESTER
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State | TN
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Zip | 37349-0749
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Country | US
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Telephone | 931-728-5522
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Fax | 931-728-2247
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID G FLORENCE
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Credential | D.O.
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Telephone | 931-728-5522
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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 | 0604
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License Number State | TN
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