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General NPI Number Information
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NPI Number | 1700913365
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Entity Type | Organization
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Legal Business Name | ETOWAH FAMILY PRACTICE PLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 305 GRADY RD SUITE A
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City | ETOWAH
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State | TN
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Zip | 37331-1903
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Country | US
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Telephone | 423-263-4500
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Fax | 423-263-0045
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Provider Business Mailing Address
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Address Line | 305 GRADY RD SUITE A
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City | ETOWAH
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State | TN
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Zip | 37331-1903
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Country | US
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Telephone | 423-263-4500
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Fax | 423-263-0045
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES B DURKIN
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Credential | MD
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Telephone | 423-263-4500
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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 | MD0000036878
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License Number State | TN
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