Provider Demographics
NPI:1720338833
Name:CHRISTIAN FAMILY MEDICINE
Entity Type:Organization
Organization Name:CHRISTIAN FAMILY MEDICINE
Other - Org Name:CHRISTIAN FAMILY MEDCINE OF WEAKLEY COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-635-8189
Mailing Address - Street 1:105 HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-8264
Mailing Address - Country:US
Mailing Address - Phone:731-635-8189
Mailing Address - Fax:731-635-8121
Practice Address - Street 1:79 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-4580
Practice Address - Country:US
Practice Address - Phone:731-635-8189
Practice Address - Fax:731-635-8182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN FAMILY MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty