Provider Demographics
NPI:1912688250
Name:GATEWAY PRIMARY CARE LLC
Entity Type:Organization
Organization Name:GATEWAY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:WEATHERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-225-7849
Mailing Address - Street 1:1508 CARL ADAMS DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-4375
Mailing Address - Country:US
Mailing Address - Phone:615-225-7849
Mailing Address - Fax:615-962-9047
Practice Address - Street 1:1508 CARL ADAMS DR STE 400
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4375
Practice Address - Country:US
Practice Address - Phone:615-894-0990
Practice Address - Fax:615-931-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care