Provider Demographics
NPI:1053348581
Name:DOGWOOD FAMILY PRACTICE INC
Entity type:Organization
Organization Name:DOGWOOD FAMILY PRACTICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-579-0599
Mailing Address - Street 1:10622 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4703
Mailing Address - Country:US
Mailing Address - Phone:865-579-0599
Mailing Address - Fax:865-609-0808
Practice Address - Street 1:10622 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4703
Practice Address - Country:US
Practice Address - Phone:865-579-0599
Practice Address - Fax:865-609-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty