| NPI | 1649416926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DEROOS President 423-614-5654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 9519) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1830) |
| 363L00000X Nurse Practitioner (Licence: TN 15022) | |
| 363A00000X Physician Assistant (Licence: TN 1753) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 13925) | |
| 111N00000X Chiropractor (Licence: TN 1294) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2010-08-03 |