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General NPI Number Information
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NPI Number | 1508930843
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Entity Type | Individual
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Provider Name | BRIAN T FRETWELL PAC MPH
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2121 N OCOEE ST SUITE 101
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City | CLEVELAND
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State | TN
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Zip | 37311-3953
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Country | US
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Telephone | 423-472-6548
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Fax | 423-472-8318
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Provider Business Mailing Address
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Address Line | 149 HUNTERS RUN TRL NW
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City | CLEVELAND
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State | TN
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Zip | 37312-6205
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Country | US
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Telephone | 423-650-2987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1070
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License Number State | TN
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