Organization
MAIN STREET MEDICAL, PLLC
Active
Other names
Main Street Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL A MIRANDA (AUTHORIZED USER)
(423) 521-5404
Entity
Organization
Contact information
Practice address
1667 OOLTEWAH RINGGOLD RD, OOLTEWAH, TN 37363-9830
(423) 886-7545
Mailing address
326 CREEKSHIRE DR, SIGNAL MTN, TN 37377-2086
(423) 243-8196
(417) 429-2893
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/20/2011
Last updated
02/09/2020
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