Provider Demographics
NPI:1093928707
Name:LONG HOLLOW FAMILY PRACTICE
Entity Type:Organization
Organization Name:LONG HOLLOW FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAITES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-859-1440
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37070-0710
Mailing Address - Country:US
Mailing Address - Phone:615-859-1440
Mailing Address - Fax:615-859-0145
Practice Address - Street 1:740 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1915
Practice Address - Country:US
Practice Address - Phone:615-859-1440
Practice Address - Fax:615-859-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722501Medicare ID - Type Unspecified