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General NPI Number Information
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NPI Number | 1568061661
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Entity Type | Organization
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Legal Business Name | HOMETOWN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 7794 RHEA COUNTY HWY STE 101
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City | DAYTON
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State | TN
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Zip | 37321-5981
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Country | US
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Telephone | 423-775-3363
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Fax | 423-775-3366
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Provider Business Mailing Address
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Address Line | PO BOX 24927
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City | CHATTANOOGA
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State | TN
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Zip | 37422-4927
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Country | US
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Telephone | 423-643-2576
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Fax | 423-648-4570
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JENNIFER LEIGH SHAVER
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Credential | NP
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Telephone | 423-775-3363
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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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