Organization
RENOVUS MEDICAL SPA
Active
Organization
RENOVUS MEDICAL SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY BEARD (OWNER)
(423) 207-0154
Entity
Organization
Contact information
Practice address
405 ROY MARTIN RD, STE 104, GRAY, TN 37615-2551
(423) 207-0154
Mailing address
405 ROY MARTIN RD, STE 104, GRAY, TN 37615-2551
(423) 207-0154
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
17509
TN
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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