Organization
MOBILE MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG E DEAN PA (OWNER)
(615) 449-7002
Entity
Organization
Contact information
Practice address
404 CASTLE HEIGHTS AVE N, SUITE E, LEBANON, TN 37087-1511
(615) 449-7002
Mailing address
PO BOX 158, LEBANON, TN 37088-0158
(615) 449-7002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3907834
—
TN
Enumeration date
07/10/2006
Last updated
04/17/2008
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