Provider Demographics
NPI:1568061661
Name:HOMETOWN PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:HOMETOWN PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-775-3363
Mailing Address - Street 1:PO BOX 24927
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-4927
Mailing Address - Country:US
Mailing Address - Phone:423-643-2576
Mailing Address - Fax:423-648-4570
Practice Address - Street 1:7794 RHEA COUNTY HWY STE 101
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5981
Practice Address - Country:US
Practice Address - Phone:423-775-3363
Practice Address - Fax:423-775-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty