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General NPI Number Information
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NPI Number | 1285748962
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Entity Type | Organization
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Legal Business Name | PARKWAY MEDICAL GROUP, PC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 108 MEDICAL CENTER BLVD SUITE G-50
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-2741
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Country | US
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Telephone | 931-438-4111
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Fax | 931-438-6108
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Provider Business Mailing Address
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Address Line | 108 MEDICAL CENTER BLVD SUITE G-50
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-2741
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Country | US
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Telephone | 931-438-4111
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Fax | 931-438-6108
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | REBECCA L MITCHELL
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Credential |
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Telephone | 931-438-4111
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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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