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General NPI Number Information
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NPI Number | 1295033595
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Entity Type | Organization
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Legal Business Name | STATON SOUTHERN MEDICAL, PLLC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 131 HOSPITAL DRIVE SUITE 2000
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City | CARTHAGE
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State | TN
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Zip | 37030
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Country | US
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Telephone | 423-364-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 131 HOSPITAL DRIVE SUITE 2000
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City | CARTHAGE
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State | TN
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Zip | 37030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BRENT D STATON
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Credential | MD
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Telephone | 423-619-6282
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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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