# STATE OF TENNESSEE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Montgomery County WIC Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659687978
- **Authorized official:** ANNETTE HALEY (REGIONAL DIRECTOR)
- **Authorized official phone:** (615) 650-7000

## Contact information

- **Practice address:** 300 PAGEANT LN, CLARKSVILLE, TN 37040-3854
- **Practice address phone:** (931) 551-8777
- **Practice address fax:** (931) 503-0694
- **Mailing address:** 300 PAGEANT LN, CLARKSVILLE, TN 37040-3854
- **Mailing address phone:** (931) 551-8777
- **Mailing address fax:** (931) 503-0694

## Taxonomy

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

## Other

- **Enumeration date:** 08/24/2010
- **Last updated:** 08/28/2012