| NPI | 1376682633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE GARDINER Administrator 615-384-5554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2025-09-11 |