Individual
PHILLIP D TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2148 AZTEC DR, DYERSBURG, TN 38024-1841
(731) 589-6156
(615) 467-8971
Mailing address
2148 AZTEC DR, DYERSBURG, TN 38024-1841
(731) 589-6156
(615) 467-8971
Taxonomy
Speciality
Code
Description
License number
State
2279P1004X
Pulmonary Diagnostics Registered Respiratory Therapist
Primary
RRT0000000395
TN
Other
Enumeration date
10/01/2010
Last updated
06/12/2013
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