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General NPI Number Information
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NPI Number | 1841744810
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Entity Type | Organization
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Legal Business Name | FPSC, PLLC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 1021 EXECUTIVE DR SUITE 102
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City | HIXSON
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State | TN
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Zip | 37343-7918
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Country | US
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Telephone | 423-648-9808
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 EXECUTIVE DRIVE, SUITE 102 OPTIONAL
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City | HIXSON
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State | TN
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Zip | 37343
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Country | US
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Telephone | 423-531-3398
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Fax | 423-648-4570
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Authorized Official
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Title or Position | MD/OWNER
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Name | LUIS ALBERTO GOMEZ
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Credential | MD
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Telephone | 423-800-2426
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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 | 51386
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License Number State | TN
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