| NPI | 1134473655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT MICKEY MAUGHON Owner/Physician 865-429-0208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: TN MD16795) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2012-11-06 |