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General NPI Number Information
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NPI Number | 1396119327
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Entity Type | Organization
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Legal Business Name | FREEDOM MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 622 WILSON AVE
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City | TULLAHOMA
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State | TN
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Zip | 37388-3265
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Country | US
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Telephone | 931-393-2362
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Fax | 931-393-3212
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Provider Business Mailing Address
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Address Line | 622 WILSON AVE
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City | TULLAHOMA
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State | TN
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Zip | 37388-3265
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Country | US
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Telephone | 931-393-2362
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Fax | 931-393-3212
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN BARNES
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Credential |
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Telephone | 931-393-2362
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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 | TN
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