Provider Demographics
NPI:1073053666
Name:HOMETOWN HEALTHCARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE ASSOCIATES, PLLC
Other - Org Name:HOMETOWN HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:PROF
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:931-472-5353
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-0336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 NEW MIDDLETON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:GORDONSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38563-6603
Practice Address - Country:US
Practice Address - Phone:931-472-5353
Practice Address - Fax:615-334-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2509261QP2300X, 261QR1300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine