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General NPI Number Information
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NPI Number | 1508824749
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Entity Type | Organization
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Legal Business Name | SOUTHERN MEDICAL CLINICS, LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 2384 BLUE SPRINGS RD SE
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City | CLEVELAND
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State | TN
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Zip | 37311-0909
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Country | US
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Telephone | 423-728-1845
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Fax | 423-728-1925
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Provider Business Mailing Address
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Address Line | PO BOX 2515
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City | CLEVELAND
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State | TN
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Zip | 37320-2515
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Country | US
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Telephone | 423-728-1845
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Fax | 423-728-1925
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBRA LYNN CHIN
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Credential | RN
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Telephone | 423-728-1845
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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 | PA753
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD31732
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License Number State | TN
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