Provider Demographics
NPI:1689875429
Name:MCMINN MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MCMINN MEDICAL GROUP PLLC
Other - Org Name:ATHENS MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-745-6575
Mailing Address - Street 1:1031 W MADISON AVE
Mailing Address - Street 2:P.O. BOX 70
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3498
Mailing Address - Country:US
Mailing Address - Phone:423-745-6575
Mailing Address - Fax:423-746-4366
Practice Address - Street 1:1031 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3498
Practice Address - Country:US
Practice Address - Phone:423-745-6575
Practice Address - Fax:423-746-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization