Provider Demographics
NPI:1063858819
Name:FOX, BRUCE M (NP-C)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:FOX
Suffix:
Gender:M
Credentials:NP-C
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Other - Credentials:
Mailing Address - Street 1:8907 LONG SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5703
Mailing Address - Country:US
Mailing Address - Phone:423-344-8586
Mailing Address - Fax:423-344-8586
Practice Address - Street 1:513 BENJAMIN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4682
Practice Address - Country:US
Practice Address - Phone:716-217-1795
Practice Address - Fax:706-217-1814
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN084674363LF0000X
TNRN0000067661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily