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General NPI Number Information
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NPI Number | 1982949434
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Entity Type | Organization
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Legal Business Name | LYNCHBURG MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 40 LYNCHBURG HWY
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City | LYNCHBURG
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State | TN
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Zip | 37352-7449
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Country | US
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Telephone | 931-759-4197
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Fax | 931-759-6673
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Provider Business Mailing Address
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Address Line | 100 WILLIAM NORTHERN BLVD
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City | TULLAHOMA
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State | TN
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Zip | 37388-4754
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Country | US
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Telephone | 931-454-0489
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Fax | 931-454-1227
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Authorized Official
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Title or Position | MEMBER
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Name | BRETT L FERRELL
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Credential | MD
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Telephone | 931-454-0489
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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 | 47136
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License Number State | TN
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