| NPI | 1417961251 |
|---|---|
| Other Name | PROFESSIONAL STAFF |
| Entity Type | Organization |
| Authorized Contact | SHAVER MIKE Director Of Reimbursement 423-778-4712 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC H0239) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC HO239) |
| 207P00000X Emergency Medicine (Licence: NC H0239) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-07-15 |