Provider Demographics
NPI:1700913365
Name:ETOWAH FAMILY PRACTICE PLC
Entity Type:Organization
Organization Name:ETOWAH FAMILY PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-263-4500
Mailing Address - Street 1:305 GRADY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-1903
Mailing Address - Country:US
Mailing Address - Phone:423-263-4500
Mailing Address - Fax:423-263-0045
Practice Address - Street 1:305 GRADY RD
Practice Address - Street 2:SUITE A
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1903
Practice Address - Country:US
Practice Address - Phone:423-263-4500
Practice Address - Fax:423-263-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2308972OtherCIGNA
TN4051202OtherBCBS
TN7892455OtherAETNA
TN3880122Medicaid
TNP00092170OtherRR MEDICARE
TNTN0101OtherUHC/JD
TN3880123Medicare PIN
TN4051202OtherBCBS