Organization
LOUDON COUNTY PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWIGHT DANIEL BIVENS (SECRETARY/TREASURER)
(865) 986-9233
Entity
Organization
Contact information
Practice address
423 MEDICAL PARK DR, LENOIR CITY, TN 37772-5640
(865) 986-9233
(865) 986-0148
Mailing address
423 MEDICAL PARK DR, LENOIR CITY, TN 37772-5640
(865) 986-9233
(865) 986-0148
Taxonomy
Speciality
Code
Description
License number
State
364SP0200X
Pediatric Clinical Nurse Specialist
Primary
145961
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265462287
NPPES
TN
01
—
1841514155
NPPES
TN
Enumeration date
05/06/2010
Last updated
05/06/2010
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