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General NPI Number Information
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NPI Number | 1285795278
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Entity Type | Organization
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Legal Business Name | HEALING PLACE FAMILY MEDICINE
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 824 WREN RD
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-2312
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Country | US
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Telephone | 615-851-8959
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Fax | 615-851-5949
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Provider Business Mailing Address
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Address Line | 824 WREN RD
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-2312
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Country | US
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Telephone | 615-851-8959
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Fax | 615-851-5949
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD MCDERMOTT
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Credential | MEDICAL DOCTOR
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Telephone | 615-851-8959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | TN
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