Organization
COFFEE COUNTY PHYSICIAN GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WARE (CEO)
(615) 732-0560
Entity
Organization
Contact information
Practice address
481 INTERSTATE DR, MANCHESTER, TN 37355-3108
(931) 728-6354
Mailing address
PO BOX 830525 DEPT SF 125, BIRMINGHAM, AL 35283-0525
(601) 368-3290
(601) 936-4389
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345103
—
AL
05
—
3727643
—
TN
Enumeration date
07/31/2006
Last updated
05/02/2025
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