Organization
SOMERVILLE MEDICAL CLINIC,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYNOR SHOAF (OFFICE MANAGER)
(901) 465-5466
Entity
Organization
Contact information
Practice address
213 LAKEVIEW RD, SOMERVILLE, TN 38068-9744
(901) 465-5466
(901) 465-9048
Mailing address
PO BOX 640, SOMERVILLE, TN 38068-0640
(901) 465-5466
(901) 465-9048
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437245792
JAMEY COLSTON FNP NPI
TN
01
—
1487748745
DR. DAVID SEATON NPI
TN
05
—
1518107
—
TN
01
—
1629018981
ASHLEY CRAWFORD FNP NPI
TN
01
—
1972834414
SOMERVILLE MEDICAL CLINIC,INC NPI
TN
01
—
4108029
BLUE CROSS GROUP
TN
Enumeration date
01/22/2010
Last updated
01/20/2011
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