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Organization
COVENANT FAMILY PRACTICE, PC
Active
Organization
COVENANT FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ALAN WILSON MD (PRESIDENT)
(931) 245-1150
Entity
Organization
Contact information
Practice address
1000 HIGHWAY 76, CLARKSVILLE, TN 37043-8405
(931) 245-8000
(931) 245-0605
Mailing address
PO BOX 30459, CLARKSVILLE, TN 37040-0008
(931) 245-8000
(931) 245-0605
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3718348
—
TN
01
—
4062086
TN BCBS
TN
Enumeration date
06/17/2006
Last updated
11/05/2019
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