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NPI Code Detail

MEDICARE: FAMILY CHRISTIAN CARE CENTER, LLC

MEDICARE: FAMILY CHRISTIAN CARE CENTER, LLC
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
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1194431502
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY CHRISTIAN CARE CENTER, LLC
Provider Business Mailing Address
First Line : 2200 CHAMBLISS AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3874
Country : US
Telephone Number : 423-599-9347
Fax Number : 866-369-7656
Provider Business Practice Location Address
First Line : 2200 CHAMBLISS AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3874
Country : US
Telephone Number : 423-599-9347
Fax Number :
Authorized Official
Title or Position : OWNER-PHYSICIAN ASSISTANT
Name : DR. JENNIFER D WALKER
Credential : DMSC, PA-C
Telephone Number : 423-599-9347
Provider Enumeration Date : 01/30/2023
Last Update Date : 06/22/2023

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Directions to “FAMILY CHRISTIAN CARE CENTER, LLC ” Practice Location

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