Clearwater Investments Inc Byrdstown Medical

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CLEARWATER INVESTMENTS INC BYRDSTOWN MEDICAL

Doing business as

Byrdstown Medical

Practice address

8401 Hwy 111
Byrdstown, TN 38549-1006

Phone

(931) 864-3187

Fax

(931) 864-7102

NPI assigned

Aug 9, 2006

Last updated

Feb 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deedee Johnson

Title

Credentialing / Systems Admin

Phone

(931) 864-3187

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 3

• Byrdstown Medical Doing business as
• Byrdstown Medical Center, PLLC Former legal business name
• Mason Farms Byrdstown Medical Center Former legal business name

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707609600000",
    "number": "1679583801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 HWY 111",
            "city": "BYRDSTOWN",
            "state": "TN",
            "postal_code": "385491006",
            "telephone_number": "931-864-3187",
            "fax_number": "931-864-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 HWY 111",
            "city": "BYRDSTOWN",
            "state": "TN",
            "postal_code": "385491006",
            "telephone_number": "931-864-3187",
            "fax_number": "931-864-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER INVESTMENTS INC BYRDSTOWN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2024-02-11",
        "certification_date": "2024-02-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DEEDEE",
        "authorized_official_title_or_position": "CREDENTIALING / SYSTEMS ADMIN",
        "authorized_official_telephone_number": "931-864-3187"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3714746",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Byrdstown Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Byrdstown Medical Center, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mason Farms Byrdstown Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mason Farms Byrdstown Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Sheila Rose Abbott, R.N.
• Kasie Racquel Beaty, CMA
• Kathy Mae Beaty, CNA
• Amanda Collier
• Cullen Cleveland Copeland Sr., MD
• Helen Amber Davidson
• Kendle Dwayne Davidson
• Davidsons Discount Drugs Inc

• Family Medicine Physician in Byrdstown, TN
• Providers in Byrdstown, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2024; 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.