| Organization Name: | PIGEON FORGE MEDICAL CLINIC |
| NPI Number: | 1427151406 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY BRADLEY (PHYSICIAN) |
| Mailing Address: | 3342 Parkway Pigeon Forge |
| State: | TN US |
| Postal Code: | 378633423 |
| Phone Number: | 8654531924 |
| Fax Number: | 8654531926 |
| NPI Enumeration Date: | 09/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 170100000X |
| License Number: | TNMD14371 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Medical Genetics, Ph.D. Medical Genetics |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists. |