Provider Demographics
NPI:1467175877
Name:DOC ON MAIN STREET FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:DOC ON MAIN STREET FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-617-6585
Mailing Address - Street 1:PO BOX 31816
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1889
Mailing Address - Country:US
Mailing Address - Phone:865-392-1888
Mailing Address - Fax:865-392-1889
Practice Address - Street 1:268 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8425
Practice Address - Country:US
Practice Address - Phone:865-392-1888
Practice Address - Fax:865-392-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty