Provider Demographics
NPI:1114071396
Name:FAMILY HEALTHCARE ASSOCIATES OF GREENBRIER
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE ASSOCIATES OF GREENBRIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-643-4534
Mailing Address - Street 1:2557 HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-5516
Mailing Address - Country:US
Mailing Address - Phone:615-643-4534
Mailing Address - Fax:615-643-4537
Practice Address - Street 1:2557 HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:TN
Practice Address - Zip Code:37073-5516
Practice Address - Country:US
Practice Address - Phone:615-643-4534
Practice Address - Fax:615-643-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719347Medicaid
TN371934Medicare ID - Type UnspecifiedGROUP #