Provider Demographics
NPI:1386075976
Name:TENNESSEE VALLEY FAMILY PRACTICE ASSOCIATES PC
Entity type:Organization
Organization Name:TENNESSEE VALLEY FAMILY PRACTICE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-437-0555
Mailing Address - Street 1:47053 AL HIGHWAY 277
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRIDGEPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35740-7205
Mailing Address - Country:US
Mailing Address - Phone:256-437-0555
Mailing Address - Fax:
Practice Address - Street 1:47053 AL HIGHWAY 277
Practice Address - Street 2:SUITE C
Practice Address - City:BRIDGEPORT
Practice Address - State:AL
Practice Address - Zip Code:35740-7205
Practice Address - Country:US
Practice Address - Phone:256-437-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBO3856Medicare UPIN