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General NPI Number Information
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NPI Number | 1639376353
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Entity Type | Organization
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Legal Business Name | STONECREST MEDICAL GROUP - FAMILY PRACTICE OF MURFREESBORO LLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 2706 OLD FORT PARKWAY SUITE E
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City | MURFREESBORO
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State | TN
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Zip | 37128
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Country | US
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Telephone | 615-893-1230
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Fax | 615-893-1232
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Provider Business Mailing Address
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Address Line | 2706 OLD FORT PARKWAY SUITE E
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City | MURFREESBORO
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State | TN
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Zip | 37128
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Country | US
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Telephone | 615-893-1230
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Fax | 615-893-1232
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHUCK LOCKE
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Credential |
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Telephone | 615-373-7604
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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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