Provider Demographics
NPI:1043856677
Name:PAC OF TENNESSEE PC
Entity type:Organization
Organization Name:PAC OF TENNESSEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-573-1502
Mailing Address - Street 1:6 6TH ST STE 256
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2257
Mailing Address - Country:US
Mailing Address - Phone:423-573-1502
Mailing Address - Fax:423-217-0604
Practice Address - Street 1:1958 WEST STATE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2257
Practice Address - Country:US
Practice Address - Phone:423-573-1502
Practice Address - Fax:423-217-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty