| NPI | 1396032777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIYE DUNLAP Office Manager 615-459-0566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 8170TN) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: TN 8170TN) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2011-07-06 |