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General NPI Number Information
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NPI Number | 1467175877
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Entity Type | Organization
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Legal Business Name | DOC ON MAIN STREET FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 268 N MAIN STREET
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City | ROBBINSVILLE
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State | NC
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Zip | 28771-8425
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Country | US
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Telephone | 865-392-1888
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Fax | 865-392-1889
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Provider Business Mailing Address
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Address Line | PO BOX 31816
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City | KNOXVILLE
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State | TN
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Zip | 37930-1889
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Country | US
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Telephone | 865-392-1888
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Fax | 865-392-1889
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Authorized Official
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Title or Position | OWNER
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Name | ERIC M REDMON
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Credential | M.D.
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Telephone | 865-617-6585
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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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