| NPI | 1881325306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL BURGESS Provider Enrollment Team Lead 865-670-6754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant Surgical | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2022-06-24 |