# TENNESEE DEPARTMENT OF HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649259367
- **Authorized official:** MRS. ANDREA SHANKS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (615) 650-7053

## Contact information

- **Practice address:** 330 PAGEANT LN, CLARKSVILLE, TN 37040-3854
- **Practice address phone:** (931) 648-7280
- **Practice address fax:** (931) 648-7299
- **Mailing address:** 1008 RAMBLING BROOK RD, NASHVILLE, TN 37218-3608
- **Mailing address phone:** (615) 299-0750
- **Mailing address fax:** (615) 299-0086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | DS 4582 | TN | Yes |

## Other

- **Enumeration date:** 01/11/2006
- **Last updated:** 08/22/2020