Organization
1101 PRIMARY CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN SHIRLEY (PRACTICE MANAGER)
(931) 528-7797
Entity
Organization
Contact information
Practice address
1101 NEAL ST, COOKEVILLE, TN 38501-0901
(931) 528-7797
Mailing address
1101 NEAL ST, COOKEVILLE, TN 38501-0901
(931) 528-7797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q020668
—
TN
Enumeration date
02/26/2016
Last updated
02/06/2020
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