Provider Demographics
NPI:1063552461
Name:CAROL A DEWEY
Entity type:Organization
Organization Name:CAROL A DEWEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-968-4444
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37621-0711
Mailing Address - Country:US
Mailing Address - Phone:423-968-4444
Mailing Address - Fax:
Practice Address - Street 1:522 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2307
Practice Address - Country:US
Practice Address - Phone:423-968-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02975Medicare UPIN