Provider Demographics
NPI:1184932485
Name:COMPLETE FAMILY CARE OF MARYVILLE, PLLC
Entity type:Organization
Organization Name:COMPLETE FAMILY CARE OF MARYVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:O
Authorized Official - Last Name:SUGANTHARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-982-4301
Mailing Address - Street 1:2004 E. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-982-4301
Mailing Address - Fax:865-357-8869
Practice Address - Street 1:2004 E. BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-982-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty