# UNIVERSITY OF TENNESSEE

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

## Provider details

- **NPI number:** 1780686436
- **Authorized official:** JOAN L PORTER (MANAGER)
- **Authorized official phone:** (731) 265-8220

## Contact information

- **Practice address:** 294 SUMMAR DR, JACKSON, TN 38301-3915
- **Practice address phone:** (731) 423-1932
- **Practice address fax:** (731) 423-4919
- **Mailing address:** 294 SUMMAR DR, DEPT. 289, JACKSON, TN 38301-3915
- **Mailing address phone:** (731) 265-8220
- **Mailing address fax:** (731) 265-8355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | TN | Yes |

## Other

- **Enumeration date:** 08/12/2005
- **Last updated:** 07/21/2022