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General NPI Number Information
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NPI Number | 1437703741
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Entity Type | Organization
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Legal Business Name | PROVIDENCE FAMILY MEDICINE
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 287 W TURN TABLE RD
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City | SPARTA
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State | TN
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Zip | 38583-1366
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Country | US
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Telephone | 931-836-3262
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Fax | 931-836-3269
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Provider Business Mailing Address
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Address Line | 287 W TURN TABLE RD
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City | SPARTA
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State | TN
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Zip | 38583-1366
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Country | US
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Telephone | 931-836-3262
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Fax | 931-836-3269
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATINA E HUFF
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Credential | PAC
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Telephone | 931-836-3262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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