| Atoka Idaville Family Health, Inc | |
|
5847 Atoka Idaville Rd Brighton TN 38011-7066 | |
| (901) 304-8709 | |
| Not Available |
| Full Name | Atoka Idaville Family Health, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5847 Atoka Idaville Rd, Brighton, Tennessee |
| Authorized Official Name and Position | Robyn Yvette Vanderford (OWNER/PROVIDER) |
| Authorized Official Contact | 9018370701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atoka Idaville Family Health, Inc 5847 Atoka Idaville Rd Brighton TN 38011-7066 Ph: (901) 837-0701 | Atoka Idaville Family Health, Inc 5847 Atoka Idaville Rd Brighton TN 38011-7066 Ph: (901) 304-8709 |
| NPI Number | 1962861310 |
|---|---|
| Provider Enumeration Date | 02/13/2016 |
| Last Update Date | 09/30/2022 |
| Medicare PECOS PAC ID | 6103123526 |
|---|---|
| Medicare Enrollment ID | O20160330002396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962861310 | NPI | - | NPPES |
| 3703407 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 13123 (Tennessee) | Primary |
| 363LF0000X | Nurse Practitioner - Family | 2007009643 (Tennessee) | Secondary |
| Provider Name | Robyn Vanderford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437334216 PECOS PAC ID: 6305065962 Enrollment ID: I20160330002504 |
| Provider Name | Pamela F Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528676707 PECOS PAC ID: 4082033873 Enrollment ID: I20200928002810 |
Dr. Jesse Cannon Jr. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7615 Highway 51 S Ste 106, Brighton, TN 38011 Phone: 901-837-7568 Fax: 901-837-7532 | |
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