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General NPI Number Information
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NPI Number | 1629301957
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Entity Type | Organization
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Legal Business Name | CIRCLE OF LIFE FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 4841 HIXSON PIKE SUITE A
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City | HIXSON
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State | TN
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Zip | 37343-4431
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Country | US
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Telephone | 423-305-7980
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Fax | 423-305-7981
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Provider Business Mailing Address
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Address Line | 4841 HIXSON PIKE SUITE A
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City | HIXSON
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State | TN
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Zip | 37343-4431
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Country | US
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Telephone | 423-305-7980
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Fax | 423-305-7981
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW C. TINNEY
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Credential | DO
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Telephone | 423-305-7980
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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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