Provider Demographics
NPI:1164099339
Name:COVENANT MEDICAL FAIRVIEW, PC
Entity Type:Organization
Organization Name:COVENANT MEDICAL FAIRVIEW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-218-8566
Mailing Address - Street 1:2340 FAIRVIEW BLVD STE 600D
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9457
Mailing Address - Country:US
Mailing Address - Phone:615-266-2177
Mailing Address - Fax:
Practice Address - Street 1:2340 FAIRVIEW BLVD STE 600D
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9457
Practice Address - Country:US
Practice Address - Phone:615-266-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty