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General NPI Number Information
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NPI Number | 1790984219
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CLINIC OF MORRISTOWN
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 1907 W MORRIS BLVD STE B
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City | MORRISTOWN
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State | TN
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Zip | 37813-3860
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Country | US
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Telephone | 423-587-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 W MORRIS BLVD STE B
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City | MORRISTOWN
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State | TN
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Zip | 37813-3860
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Country | US
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Telephone | 423-587-2707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL JAMES MARTIN
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Credential | PA-C
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Telephone | 423-587-2707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PA746
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License Number State | TN
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