| NPI | 1629581574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS E LILLIFIELD Owner 865-247-5590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 174) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TN 174) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2017-11-14 |