MEDICARE: ONE TO ONE HEALTH PLLC

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	207Q00000X	Family Medicine Physician	11700	TN

General Provider Information

NPI Number	:	1245775204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE TO ONE HEALTH PLLC

Provider Business Mailing Address
First Line	:	932 S BROADWAY ST
Second Line	:	SUITE B
City	:	PORTLAND
State	:	TN
Zip	:	37148-1651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 S BROADWAY ST
Second Line	:	SUITE B
City	:	PORTLAND
State	:	TN
Zip	:	37148-1651
Country	:	US
Telephone Number	:	423-718-9188
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JOE COFER
Credential	:	MD
Telephone Number	:	423-718-9188

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	12/30/2016

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