Organization
FAMILY PRACTICE OF COVINGTON, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SOPHIA MICHELLE JOHNSON (ADMINISTRATIVE ASSISTANT)
(901) 475-4752
Entity
Organization
Contact information
Practice address
4235 HIGHWAY 51 SOUTH, BRIGHTON, TN 38011-6921
(901) 475-4752
(901) 475-1554
Mailing address
P.O. BOX 507, COVINGTON, TN 38019-0507
(901) 475-4752
(901) 475-1554
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD11374
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
268267
UNISON ADVANTAGE
TN
01
—
27017
TLC
TN
05
—
3718265
—
TN
01
—
4063363
BCBSTN
TN
01
—
4229920
BLUE CROSS BLUE SHIELD OF TN
TN
Enumeration date
07/03/2007
Last updated
08/18/2009
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