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General NPI Number Information
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NPI Number | 1295805794
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 1407 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 615-444-6203
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Fax | 615-444-6252
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Provider Business Mailing Address
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Address Line | 1407 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 615-444-6203
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Fax | 615-444-6252
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. ROGER E MCKINNEY
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Credential | M.D.
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Telephone | 615-444-6203
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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 | 5949
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License Number State | TN
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