Provider Demographics
NPI:1629108691
Name:PHYSICIAN FIRST PC
Entity Type:Organization
Organization Name:PHYSICIAN FIRST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-476-3330
Mailing Address - Street 1:2725 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-476-3330
Mailing Address - Fax:423-476-5802
Practice Address - Street 1:2725 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-476-3330
Practice Address - Fax:423-476-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD015727207Q00000X
TNPA0000000148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841466Medicaid
TN4009361OtherBCBS
A97400Medicare UPIN
TN3841466Medicaid