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Individual

MR. TIMOTHY E VIVIAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
675 SOUTH JEFFERSON AVE, COOKEVILLE, TN 38501-0949
(931) 520-0148
(931) 520-0152
Mailing address
675 SOUTH JEFFERSON AVE, COOKEVILLE, TN 38501-0949
(931) 520-0148
(931) 520-0152

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
P0770
TN

Other

Enumeration date
09/13/2005
Last updated
06/20/2012
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