Provider Demographics
NPI:1245752997
Name:FAMILY PRACTICE OF CORRYTON
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF CORRYTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-992-3031
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-0088
Mailing Address - Country:US
Mailing Address - Phone:865-992-3031
Mailing Address - Fax:865-992-8103
Practice Address - Street 1:7701 CORRYTON RD
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-2630
Practice Address - Country:US
Practice Address - Phone:865-247-6263
Practice Address - Fax:865-992-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty