| NPI | 1700942158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA CAROLYN KELLY Office Manager 615-329-9082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD18157) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD15285) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |