1101 Primary Care, PLLC
Family Medicine in Cookeville, TN. Organization (NPI-2).
NPI number1083074587
StatusActive
Last updated in NPPESFeb 6, 2020
Details
- NPI
- 1083074587
- Entity type
- Organization (NPI-2)
- Legal business name
- 1101 Primary Care, PLLC
- Organization subpart
- No
- Enumeration date
- Feb 26, 2016
- Certification date
- Feb 6, 2020
- Last updated
- Feb 6, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
1101 Neal StCookeville, TN 38501-0901
Phone 931-528-7797
Mailing address
1101 Neal StCookeville, TN 38501-0901
Phone 931-528-7797
Authorized official
Carolyn Shirley
Practice Manager
9315287797
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