Provider Demographics
NPI:1518924760
Name:WHOLE FAMILY CLINIC, PLLC
Entity Type:Organization
Organization Name:WHOLE FAMILY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-6800
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-1065
Mailing Address - Country:US
Mailing Address - Phone:931-728-6800
Mailing Address - Fax:931-728-2911
Practice Address - Street 1:1301 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2425
Practice Address - Country:US
Practice Address - Phone:931-728-6800
Practice Address - Fax:931-728-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720833Medicaid
TN3720833Medicaid