| NPI | 1770852733 |
|---|---|
| Other Name | COMMUNITY CARE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | RUSSELL E LEWIS Executive Director 423-433-6050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: TN MD31588) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD31588) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |