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Organization

PROACTIVE MD, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PHILLIP D TIDWELL RRT (REGISTERED RESPIRATORY THERAPIST)
(731) 589-6156
Entity
Organization

Contact information

Practice address
2148 AZTEC DR, DYERSBURG, TN 38024-1841
(731) 589-6156
(615) 467-8971
Mailing address
2148 AZTEC DR, DYERSBURG, TN 38024-1841
(731) 589-6156
(615) 467-8971

Taxonomy

Speciality
Code
Description
License number
State
2279P1004X
Pulmonary Diagnostics Registered Respiratory Therapist
Primary
RRT0000000395
TN

Other

Enumeration date
03/14/2011
Last updated
06/12/2013
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