| NPI | 1972077840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER W BROOKS Pa/Owner 423-620-0575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-15 |