| NPI | 1821392937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNDY NICELY Practice Manager 865-992-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1510) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2011-01-04 |