Provider Demographics
NPI:1952572489
Name:ASSOCIATES OF FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:ASSOCIATES OF FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:901-872-6963
Mailing Address - Street 1:7889 ASTORIA
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053
Mailing Address - Country:US
Mailing Address - Phone:901-872-6963
Mailing Address - Fax:
Practice Address - Street 1:7889 ASTORIA
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053
Practice Address - Country:US
Practice Address - Phone:901-872-6963
Practice Address - Fax:901-872-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty