Individual
CHAD TILLMAN COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2154 GOODMAN RD W # 1, HORN LAKE, MS 38637-1303
(662) 393-9200
Mailing address
108 HENRY ANNA LN, BRISTOL, TN 37620-3144
(423) 956-4923
(423) 956-4923
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
111252
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2025
Last updated
06/27/2025
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