Organization
STATE OF TENNESSEE
Active
Other names
Sumner County Portland Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE HALEY (REGIONAL DIRECTOR)
(615) 650-7000
Entity
Organization
Contact information
Practice address
214 WEST LONGVIEW DRIVE, PORTLAND, TN 37148
(615) 325-5237
(615) 325-5549
Mailing address
214 WEST LONGVIEW DRIVE, PORTLAND, TN 37148
(615) 325-5237
(615) 325-5549
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1511601
—
TN
Enumeration date
12/27/2007
Last updated
08/28/2012
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