| NPI | 1902991433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI LYNN JOHNSON-HIETT Practice Manager 615-284-4680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN 22045) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-01-20 |