| NPI | 1104302413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN PORTER Director 615-500-2199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2024-08-15 |