| NPI | 1770562142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLINE B TUCK Administrator 931-455-2674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2022-06-14 |