Organization
COVENANT MEDCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN M KERLEY D.O. (OWNER PHYSICIAN)
(423) 949-9200
Entity
Organization
Contact information
Practice address
15324 RANKIN AVENUE, DUNLAP, TN 37327
(423) 949-9200
(423) 949-9203
Mailing address
PO BOX 985, 15324 RANKIN AVE, DUNLAP, TN 37327-0985
(423) 949-9200
(423) 949-9203
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO0000001427
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3726561
MEDICARE PTAN
TN
Enumeration date
07/05/2007
Last updated
09/10/2008
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