Organization
EAST WOOD CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA DAVID ROBERTS (ADMINISTRATOR)
(731) 641-8728
Entity
Organization
Contact information
Practice address
1323 EAST WOOD STREET, PARIS, TN 38242-4421
(731) 642-2011
(731) 644-2758
Mailing address
1323 EAST WOOD STREET, PARIS, TN 38242-4421
(731) 642-2011
(731) 644-2758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3731888
—
TN
Enumeration date
10/02/2006
Last updated
10/08/2021
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