| NPI | 1366993263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LOUISE PINSON Office Administrator 865-200-8672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2019-11-27 |