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General NPI Number Information
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NPI Number | 1528201126
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Entity Type | Organization
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Legal Business Name | PRIMECARE NOW OF COLUMBIA
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 1202 S JAMES CAMPBELL BLVD SUITE 15
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City | COLUMBIA
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State | TN
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Zip | 38401-5193
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Country | US
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Telephone | 931-388-0450
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Fax | 931-388-0460
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Provider Business Mailing Address
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Address Line | 1202 SOUTH JAMES CAMPBELL BOULEVARD SUITE 15
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City | COLUMBIA
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State | TN
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Zip | 38401
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Country | US
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Telephone | 931-388-0450
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Fax | 931-388-0460
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELLEN N FENNEL
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Credential |
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Telephone | 931-388-0450
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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 |
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License Number State |
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