Provider Demographics
NPI:1629139167
Name:FAMILY FIRST MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-875-4172
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45118-0231
Mailing Address - Country:US
Mailing Address - Phone:513-875-4172
Mailing Address - Fax:
Practice Address - Street 1:4313 BALL CAMP PIKE
Practice Address - Street 2:1ST FLOOR STE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3334
Practice Address - Country:US
Practice Address - Phone:513-875-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty