MEDICARE: MEDICAL GROUP-STONECREST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184611501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL GROUP-STONECREST INC

Provider Business Mailing Address
First Line	:	300 STONECREST BLVD
Second Line	:	SUITE 110
City	:	SMYRNA
State	:	TN
Zip	:	37167-5688
Country	:	US
Telephone Number	:	615-223-9233
Fax Number	:	615-768-7833

Provider Business Practice Location Address
First Line	:	300 STONECREST BLVD
Second Line	:	SUITE 110
City	:	SMYRNA
State	:	TN
Zip	:	37167-5688
Country	:	US
Telephone Number	:	615-223-9233
Fax Number	:	615-768-7833

Authorized Official
Title or Position	:	VP
Name	:	MR. CHUCK LOCKE
Credential	:
Telephone Number	:	615-373-7604

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	01/15/2008

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Directions to “MEDICAL GROUP-STONECREST INC ” Practice Location

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