# EVERNORTH CARE PROVIDERS - TENNESSEE PC

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

## Provider details

- **NPI number:** 1689431132
- **Authorized official:** GRACE BLUE (CREDENTIALING SR. MANAGER)
- **Authorized official phone:** (773) 292-4800

## Contact information

- **Practice address:** 400 W CAPITOL AVE STE 1700, LITTLE ROCK, AR 72201-3438
- **Practice address phone:** (773) 292-4800
- **Practice address fax:** (312) 564-4059
- **Mailing address:** 730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN 37067-7331
- **Mailing address phone:** (773) 292-4800
- **Mailing address fax:** (312) 564-4059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/01/2024
- **Last updated:** 03/01/2024