Organization
JOHN C MCKEOWN, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON WATTENBARGER (CREDENTIALING/BILLING MANAGER)
(423) 472-7938
Entity
Organization
Contact information
Practice address
2578 MAIN ST, PALMER, TN 37365-2730
(931) 779-3691
(931) 779-3690
Mailing address
PO BOX 100, PALMER, TN 37365-0100
(931) 779-3691
(931) 779-3690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD029059
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514317
—
TN
01
—
6040299
BCBS
TN
Enumeration date
10/13/2015
Last updated
10/13/2015
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