Provider Demographics
NPI:1861794752
Name:EAGLE FAMILY MEDICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:EAGLE FAMILY MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-456-6057
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0787
Mailing Address - Country:US
Mailing Address - Phone:931-456-6057
Mailing Address - Fax:931-707-1954
Practice Address - Street 1:13 BOB TOLLETT LOOP
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2835
Practice Address - Country:US
Practice Address - Phone:931-456-6057
Practice Address - Fax:931-707-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-27
Last Update Date:2010-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care