Organization
CLARKSVILLE HEALTH SYSTEM GP
Active
Parent organization
CLARKSVILLE HEALTH SYSTEM GP
Other names
Gateway Health System
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLARKSVILLE HEALTH SYSTEM GP
Authorized official
REBECCA HURLEY (SENIOR VICE PRESIDENT)
(214) 473-3993
Entity
Organization
Contact information
Practice address
1771 MADISON ST, CLARKSVILLE, TN 37043-4990
(931) 552-6622
(931) 551-1027
Mailing address
PO BOX 403765, ATLANTA, GA 30384-3765
(931) 552-6622
(931) 551-1027
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003823097
—
TN
Enumeration date
08/02/2006
Last updated
07/24/2007
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