Organization
FAMILY AND CHILDRENS CLINIC OF MACON COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERNA BAIN MD (OWNER)
(615) 325-5000
Entity
Organization
Contact information
Practice address
105 E MARKET ST, PORTLAND, TN 37148-1228
(615) 325-5000
(615) 323-8400
Mailing address
105 E MARKET ST, PORTLAND, TN 37148-1228
(615) 325-5000
(615) 323-8400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31162
TN
208000000X
Pediatrics Physician
31162
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3711400
—
TN
Enumeration date
10/22/2007
Last updated
12/19/2014
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