Provider Demographics
NPI:1427554492
Name:RIVERCITY FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:RIVERCITY FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVITABILE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:423-645-2228
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0307
Mailing Address - Country:US
Mailing Address - Phone:423-802-1919
Mailing Address - Fax:423-269-6178
Practice Address - Street 1:6043 SHALLOWFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1653
Practice Address - Country:US
Practice Address - Phone:423-802-1919
Practice Address - Fax:423-269-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty