| NPI | 1225835754 |
|---|---|
| Doing Business As | HOMETOWN PEDIATRIC JEFFERSON CITY |
| Entity Type | Organization |
| Authorized Contact | SANDRA DEE BOWLES Provider Enrollment Coordinator 865-584-4747 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2025-03-27 |