| NPI | 1952728289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK LYNN HICKS Physician 423-914-3195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000015018) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2014-03-25 |