Individual
PAYTON MACKENZIE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3441 DICKERSON PIKE, NASHVILLE, TN 37207-2539
(615) 769-2000
Mailing address
17 CAMP RAVINE TRL, BURNS, TN 37029-5051
(615) 707-9076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
TN
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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