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General NPI Number Information
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NPI Number | 1730207291
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Entity Type | Organization
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Legal Business Name | FCM-MTC MEDICAL LLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 95 WHITE BRIDGE RD SUITE 219
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City | NASHVILLE
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State | TN
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Zip | 37205-1497
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Country | US
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Telephone | 615-356-1666
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Fax | 888-239-5081
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Provider Business Mailing Address
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Address Line | 95 WHITE BRIDGE RD SUITE 219
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City | NASHVILLE
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State | TN
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Zip | 37205-1497
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Country | US
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Telephone | 615-356-1666
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Fax | 888-239-5081
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Authorized Official
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Title or Position | STATE MEDICAL DIRECTOR
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Name | DR. ROBERTA RAINEY FRANCES BURNS
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Credential | M.D.
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Telephone | 615-356-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State | TN
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