Organization
RENEWED LIFESTYLES INC
Active
Other names
RENEWED LIFESTYLES INC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID TERRY (PHYSCIAN)
(865) 271-8241
Entity
Organization
Contact information
Practice address
402 GREENBELT DR, MARYVILLE, TN 37804-5702
(865) 271-8241
Mailing address
402 GREENBELT DR, MARYVILLE, TN 37804-5702
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104856772
NPI
TN
Enumeration date
10/11/2018
Last updated
10/11/2018
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