PROVIDENCE PEDIATRICS, LLC

GRAY, TN
NPI1821497942
Entity TypeOrganization
Authorized ContactSUSAN KAY PENNYPACKER
Owner
423-477-2042
Organization Subpart ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: TN  6966)
Enumeration Date2014-08-14
Last Update Date2014-08-14
Business Address
PROVIDENCE PEDIATRICS, LLC
140 OLD GRAY STATION ROAD SUITE 200
GRAY, TN 37615-3612
Phone number: 423-477-2042
Mailing Address
PROVIDENCE PEDIATRICS, LLC
140 OLD GRAY STATION ROAD SUITE 200
GRAY, TN 37615-3612
Phone number: 423-477-2042
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