| NPI | 1689066649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL DEWAYNE HENSON Practice Manager 615-477-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: GA 073306) |
| Enumeration Date | 2015-02-28 |
| Last Update Date | 2015-02-28 |