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General NPI Number Information
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NPI Number | 1265689533
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Entity Type | Organization
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Legal Business Name | GARY W COLE
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 305 DOVER RD
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City | CLARKSVILLE
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State | TN
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Zip | 37042
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Country | US
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Telephone | 931-552-6722
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Fax | 931-572-6979
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Provider Business Mailing Address
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Address Line | 305 DOVER RD
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City | CLARKSVILLE
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State | TN
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Zip | 37042
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Country | US
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Telephone | 931-552-6722
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Fax | 931-552-6979
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY W COLE
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Credential | DO
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Telephone | 931-552-6722
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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 | DO1558
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License Number State | TN
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