Organization
TENNESEE DEPARTMENT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA SHANKS (CREDENTIALING COORDINATOR)
(615) 650-7053
Entity
Organization
Contact information
Practice address
330 PAGEANT LN, CLARKSVILLE, TN 37040-3854
(931) 648-7280
(931) 648-7299
Mailing address
1008 RAMBLING BROOK RD, NASHVILLE, TN 37218-3608
(615) 299-0750
(615) 299-0086
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
DS 4582
TN
Other
Enumeration date
01/11/2006
Last updated
08/22/2020
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