| NPI | 1114048188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA M BERRY Md 423-745-2676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TN 30252) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |