Provider Demographics
NPI:1013481704
Name:DRS COFFEY INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:DRS COFFEY INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:HUGHETT
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-215-6957
Mailing Address - Street 1:377 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6276
Mailing Address - Country:US
Mailing Address - Phone:423-286-4000
Mailing Address - Fax:423-286-4001
Practice Address - Street 1:377 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6276
Practice Address - Country:US
Practice Address - Phone:423-286-4000
Practice Address - Fax:423-286-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2651OtherDOCTOR OF OSTEOPATHY
TN48605OtherMEDICAL LICENSE
TN09950OtherMEDICAL LICENSE
TN22393OtherAPRN