Organization
WALK IN CLINIC OF SPARTA LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE DURBIN PHYSICIAN ASSISTANT (PRESIDENT)
(931) 836-2228
Entity
Organization
Contact information
Practice address
396 N SPRING ST, SPARTA, TN 38583-1327
(931) 836-2228
Mailing address
396 N SPRING ST, SPARTA, TN 38583-1327
(931) 836-2228
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA0000000834
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3725921
MEDICARE GROUP PTAN NUMBER
TN
Enumeration date
02/27/2007
Last updated
03/02/2009
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