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General NPI Number Information
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NPI Number | 1912326539
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Entity Type | Organization
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Legal Business Name | 45 URGENT CARE, P.C.
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 149 N STAR DR
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City | JACKSON
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State | TN
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Zip | 38305-5634
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Country | US
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Telephone | 731-554-0571
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Fax | 731-664-7161
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Provider Business Mailing Address
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Address Line | 2012 GREYSTONE SQ
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City | JACKSON
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State | TN
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Zip | 38305-3575
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Country | US
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Telephone | 731-664-6998
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Fax | 731-664-7161
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHANNON L BONE
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Credential | D.C.
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Telephone | 731-664-6998
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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 | 34403
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License Number State | TN
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