Organization
COVENANT MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE G UTTERBACK (VP FINANCIAL SERVICES)
(865) 374-5119
Entity
Organization
Contact information
Practice address
423 MEDICAL PARK DR, STE 100, LENOIR CITY, TN 37772-5640
(865) 271-6575
(865) 986-7807
Mailing address
1400 CENTERPOINT BLVD, BLDG A, STE 202, KNOXVILLE, TN 37932-1979
(865) 374-5200
(865) 374-5201
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3734041
—
TN
Enumeration date
08/16/2011
Last updated
02/17/2016
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