NPIMap

Organization Active NPI

Wynn Habersham Community Clinic Inc

  • Rural Health Clinic/Center
  • La Follette, TN
National Provider Identifier
1417093857
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WYNN HABERSHAM COMMUNITY CLINIC INC
Practice address
1037 Stinking Creek Rd
La Follette, TN 37766-6108
Phone
(423) 784-5110
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles H. Wilkens, M.D.
Title
Owner
Phone
(423) 784-5110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1037 Stinking Creek Rd
La Follette, TN 37766-6108

Mailing address

PO Box 946
Jellico, TN 37762-0946
Phone (423) 784-0269

National Provider Directory

National Provider Directory

Locations

1037 Stinking Creek Rd
La Follette, TN 37766
Phone (423) 784-5110

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1417093857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 946",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377620946",
            "telephone_number": "423-784-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1037 STINKING CREEK RD",
            "city": "LA FOLLETTE",
            "state": "TN",
            "postal_code": "377666108",
            "telephone_number": "423-784-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYNN HABERSHAM COMMUNITY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "WILKENS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-784-5110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Follette, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.