| NPI | 1912563628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAURAV SHAH Owner 423-747-6025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-05-28 |