Organization
FAMILY MEDICAL CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE BULL APRN, FNP (MANAGING MEMBER)
(865) 687-3622
Entity
Organization
Contact information
Practice address
7331 TAZEWELL PIKE, CORRYTON, TN 37721-3516
(865) 687-3622
(865) 687-3632
Mailing address
7331 TAZEWELL PIKE, CORRYTON, TN 37721-3516
(865) 687-3622
(865) 687-3632
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
TN
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521139
—
TN
Enumeration date
07/25/2008
Last updated
03/17/2015
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