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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID LYDE MED (PRESIDENT)
(704) 450-0215
Entity
Organization

Contact information

Practice address
1002 KISER BLVD, GREENEVILLE, TN 37745-1556
(704) 450-0215
Mailing address
PO BOX 161, GREENEVILLE, TN 37744-0161
(704) 450-0215

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
12/23/2024
Last updated
12/23/2024
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