Individual
MS. BONITA MARIE SOUTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 GALLATIN PIKE S, MADISON, TN 37115-4013
(615) 460-4300
(615) 460-4380
Mailing address
620 GALLATIN PIKE S, MADISON, TN 37115-4013
(615) 460-4300
(615) 460-4380
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
085586459
TN
Other
Enumeration date
01/27/2010
Last updated
01/27/2010
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