Organization
MAIN STREET MINOR MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTY D FORD (PRACTICE MANAGER)
(931) 735-6003
Entity
Organization
Contact information
Practice address
1121 1/2 N MAIN ST, SHELBYVILLE, TN 37160-2309
(931) 735-6003
(931) 735-6152
Mailing address
1121 1/2 N MAIN ST, SHELBYVILLE, TN 37160-2309
(931) 735-6003
(931) 735-6152
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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