| NPI | 1508310012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE WHITLEY Owner/Provider 615-306-8849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TN 1195) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2016-08-12 |