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General NPI Number Information
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NPI Number | 1942698345
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH MEDICAL CORP
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 2427 PINEY GROVE CHURCH RD
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City | KNOXVILLE
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State | TN
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Zip | 37921-3765
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Country | US
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Telephone | 865-936-5635
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Fax | 865-622-3885
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Provider Business Mailing Address
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Address Line | 5210 S MIDDLEBROOK PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37921-5972
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INFRASTRUCTURE AND DESIGN CONCEPTS
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Name | THEO S STEPHENS
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Credential |
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Telephone | 865-936-5635
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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 |
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License Number State |
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