Organization
BROOKSIDE MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY SPEARS MS, ANP, BC (ADMINISTRATOR)
(423) 238-0033
Entity
Organization
Contact information
Practice address
5121 OOLTEWAH RINGGOLD ROAD, SUITE G, COLLEGEDALE, TN 37315
(423) 238-0033
Mailing address
PO BOX 793, OOLTEWAH, TN 37363-0793
(423) 238-0033
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3735307
—
TN
Enumeration date
07/25/2006
Last updated
11/30/2009
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