| NPI | 1104684505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHA GOODWIN Owner 423-413-0106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-03-11 |