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General NPI Number Information
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NPI Number | 1497071013
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Entity Type | Organization
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Legal Business Name | NEW PRIMECARE CLINICS, INC.
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 622 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1532
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Country | US
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Telephone | 731-658-2120
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Fax | 731-659-2909
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Provider Business Mailing Address
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Address Line | PO BOX 479
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City | MIDDLETON
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State | TN
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Zip | 38052-0479
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Country | US
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Telephone | 731-658-2120
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Fax | 731-659-2909
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Authorized Official
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Title or Position | MANAGER
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Name | MS. BARBARA NKOMAZANA
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Credential |
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Telephone | 731-376-1851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 38934
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License Number State | TN
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