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General NPI Number Information
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NPI Number | 1487677894
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Entity Type | Organization
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Legal Business Name | PREMIERE MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 522B BRANDIES CIR SUITE 2
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City | MURFREESBORO
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State | TN
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Zip | 37128-4872
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Country | US
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Telephone | 615-867-1602
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Fax | 615-867-1611
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Provider Business Mailing Address
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Address Line | PO BOX 332505
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City | MURFREESBORO
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State | TN
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Zip | 37133-2505
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Country | US
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Telephone | 615-867-1602
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Fax | 615-867-1611
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOREEN L VINCENT
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Credential | DO
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Telephone | 615-867-1602
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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 | DO7163
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License Number State | TN
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