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Organization
STATE OF TENNESSEE
Active
Organization
STATE OF TENNESSEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANNE SHARP (REGIONAL ACCOUNTANT)
(865) 546-9221
Entity
Organization
Contact information
Practice address
485 SULPHUR HOLLOW RD, TAZEWELL, TN 37879-5170
(865) 356-0069
Mailing address
485 SULPHUR HOLLOW RD, TAZEWELL, TN 37879-5170
(865) 356-0069
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
001533143
TN
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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