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General NPI Number Information
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NPI Number | 1265822027
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Entity Type | Organization
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Legal Business Name | CLINIC AT SELMER, PC
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 714 FEDERAL DR
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City | SELMER
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State | TN
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Zip | 38375-1876
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Country | US
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Telephone | 731-645-7952
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Fax | 731-645-8898
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Provider Business Mailing Address
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Address Line | 714 FEDERAL DR
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City | SELMER
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State | TN
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Zip | 38375-1876
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Country | US
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Telephone | 731-645-7952
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Fax | 731-645-8898
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMMED SAID BAKEER
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Credential | M.D.
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Telephone | 731-645-7952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0000015732
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN0000019130
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN0000019129
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License Number State | TN
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