Organization
NORTHSIDE MEDICAL CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R. BLENIS (ADMINISTRATOR)
(731) 668-2800
Entity
Organization
Contact information
Practice address
31 HUGHES DR, JACKSON, TN 38305-1505
(731) 668-2800
(731) 668-6161
Mailing address
31 HUGHES DR, JACKSON, TN 38305-1505
(731) 668-2800
(731) 668-6161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/29/2006
Last updated
12/04/2012
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