| NPI | 1124497730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL D RADICAN President 901-682-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX MD430532) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC1171) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: TN APN17897) | |
| 363LF0000X Nurse Practitioner Family (Licence: TN APN2519467) | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2015-09-24 |