Organization
FAMILY CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HANNA C ILLA MD (OWNER)
(615) 666-6425
Entity
Organization
Contact information
Practice address
207 WEST LOCUST STREET, LAFAYETTE, TN 37083
(615) 666-6425
(615) 666-3261
Mailing address
207 WEST LOCUST STREET, LAFAYETTE, TN 37083
(615) 666-6425
(615) 666-3261
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD30470
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3828728
—
TN
Enumeration date
11/10/2006
Last updated
08/22/2020
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