MEDICARE: CARESPOT OF MT. JULIET (S. MT. JULIET ROAD), 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
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1346582517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESPOT OF MT. JULIET (S. MT. JULIET ROAD), LLC

Provider Business Mailing Address
First Line	:	PO BOX 742588
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2588
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:	972-745-4336

Provider Business Practice Location Address
First Line	:	669 S MOUNT JULIET RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-6483
Country	:	US
Telephone Number	:	615-541-4545
Fax Number	:	615-758-9648

Authorized Official
Title or Position	:	AVP REVENUE CYCLE URGENT CARE
Name	:	MRS. RHONDA MCKINNEY
Credential	:
Telephone Number	:	972-906-8162

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	01/27/2017

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