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General NPI Number Information
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NPI Number | 1558403063
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Entity Type | Organization
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Legal Business Name | CHEROKEE MEDICAL GROUP PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 500 DECATUR PIKE
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City | ATHENS
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State | TN
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Zip | 37303
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Country | US
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Telephone | 423-745-2500
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Fax | 423-745-2571
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Provider Business Mailing Address
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Address Line | PO BOX 294
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City | ATHENS
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State | TN
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Zip | 37371
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Country | US
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Telephone | 423-745-2500
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Fax | 423-745-2571
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Authorized Official
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Title or Position | CFO
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Name | MRS. KATY ELIZABETH COFFEY
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Credential | BES
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Telephone | 423-745-2500
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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 | 1261
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD28936
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1481
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License Number State | TN
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