| NPI | 1629446125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL SUZANNE MYRICK Practice Manager 931-484-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 30511) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 14809) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2025-11-14 |