# COVENANT FAMILY PRACTICE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225073166
- **Authorized official:** DR. ROBERT ALAN WILSON MD (PRESIDENT)
- **Authorized official phone:** (931) 245-1150

## Contact information

- **Practice address:** 1000 HIGHWAY 76, CLARKSVILLE, TN 37043-8405
- **Practice address phone:** (931) 245-8000
- **Practice address fax:** (931) 245-0605
- **Mailing address:** PO BOX 30459, CLARKSVILLE, TN 37040-0008
- **Mailing address phone:** (931) 245-8000
- **Mailing address fax:** (931) 245-0605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/17/2006
- **Last updated:** 11/05/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3718348 | — | TN |
| 01 | — | 4062086 | TN BCBS | TN |