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General NPI Number Information
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NPI Number | 1346963444
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Entity Type | Organization
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Legal Business Name | CCD MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 228 N FAIRMONT AVE
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City | MORRISTOWN
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State | TN
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Zip | 37814-3768
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Country | US
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Telephone | 423-586-6263
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Fax |
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Provider Business Mailing Address
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Address Line | 228 N FAIRMONT AVE
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City | MORRISTOWN
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State | TN
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Zip | 37814-3768
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Country | US
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Telephone | 423-586-6263
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | DAVID R KRAGEL
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Credential | PHARMD
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Telephone | 423-586-6263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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