# CLEARWATER INVESTMENTS INC BYRDSTOWN MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Byrdstown Medical Center, PLLC, Byrdstown Medical, Mason Farms Byrdstown Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679583801
- **Authorized official:** DEEDEE JOHNSON (CREDENTIALING / SYSTEMS ADMIN)
- **Authorized official phone:** (931) 864-3187

## Contact information

- **Practice address:** 8401 HWY 111, BYRDSTOWN, TN 38549-1006
- **Practice address phone:** (931) 864-3187
- **Practice address fax:** (931) 864-7102
- **Mailing address:** 8401 HWY 111, BYRDSTOWN, TN 38549-1006
- **Mailing address phone:** (931) 864-3187
- **Mailing address fax:** (931) 864-7102

## Taxonomy

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

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 02/11/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3714746 | — | TN |