| NPI | 1821523101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAVER T SHATTUCK President 865-633-9068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2017-06-20 |