Organization
UNIVERSITY OF TENNESSEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN L PORTER (MANAGER)
(731) 664-0994
Entity
Organization
Contact information
Practice address
1999 HIGHWAY 51 S, COVINGTON, TN 38019-3630
(901) 476-4457
(901) 475-4389
Mailing address
16 BRENTSHIRE SQ, JACKSON, TN 38305-2203
(731) 664-0994
(731) 664-0866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3713024
—
TN
Enumeration date
08/15/2005
Last updated
07/21/2022
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