Provider Demographics
NPI:1144521873
Name:HOLISTIC FAMILY CARE
Entity type:Organization
Organization Name:HOLISTIC FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-986-0231
Mailing Address - Street 1:1559 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6237
Mailing Address - Country:US
Mailing Address - Phone:865-986-0231
Mailing Address - Fax:865-986-4036
Practice Address - Street 1:1559 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6237
Practice Address - Country:US
Practice Address - Phone:865-986-0231
Practice Address - Fax:865-986-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty