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General NPI Number Information
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NPI Number | 1558045336
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL MISSION PLLC
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Dates
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Enumeration Date | 06/13/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 150 E DIVISION RD STE 1
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City | OAK RIDGE
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State | TN
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Zip | 37830-6997
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Country | US
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Telephone | 865-205-2942
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Fax | 865-297-4917
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Provider Business Mailing Address
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Address Line | 150 E DIVISION RD STE 1
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City | OAK RIDGE
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State | TN
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Zip | 37830-6997
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Country | US
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Telephone | 865-205-2942
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Fax | 865-297-4917
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Authorized Official
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Title or Position | OWNER
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Name | SHERE HOWALD CONWAY
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Credential | MD
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Telephone | 865-205-2942
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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 |
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License Number State |
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