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General NPI Number Information
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NPI Number | 1619113867
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Entity Type | Organization
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Legal Business Name | LOGAN FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 8845 RHEA COUNTY HWY
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City | DAYTON
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State | TN
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Zip | 37321-5926
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Country | US
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Telephone | 423-775-4261
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Fax | 423-775-6988
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Provider Business Mailing Address
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Address Line | 8845 RHEA COUNTY HWY
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City | DAYTON
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State | TN
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Zip | 37321-5926
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Country | US
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Telephone | 423-775-4261
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Fax | 423-775-6988
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. LEE DANIEL LOGAN
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Credential | D.O.
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Telephone | 423-775-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DO 1846
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License Number State | TN
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