| NPI | 1811731482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA DEE BOWLES Provider Enrollment COO Rdinator 865-584-4747 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2024-07-02 |