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10 Eldad Rd Fayetteville TN 37334-7005 | |
| (931) 433-2229 | |
| (931) 433-2398 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 10 Eldad Rd, Fayetteville, Tennessee |
| Authorized Official Name and Position | Karen W Campbell (OFFICE MANAGER) |
| Authorized Official Contact | 9314332229 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10 Eldad Rd Fayetteville TN 37334-7005 Ph: (931) 433-2229 | 10 Eldad Rd Fayetteville TN 37334-7005 Ph: (931) 433-2229 |
| NPI Number | 1043363492 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 12/20/2024 |
| Medicare PECOS PAC ID | 6204805450 |
|---|---|
| Medicare Enrollment ID | O20040925000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043363492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Theresa Morrison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760426704 PECOS PAC ID: 0143299396 Enrollment ID: I20100804000137 |
| Provider Name | Audra L Meeks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730338682 PECOS PAC ID: 8628263134 Enrollment ID: I20101110000565 |
| Provider Name | Kristie M Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043710478 PECOS PAC ID: 6204169477 Enrollment ID: I20190604001479 |
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