Organization
TNCOVIDDEFENSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FULLER LPN (OWNER)
(731) 358-4062
Entity
Organization
Contact information
Practice address
33 REYNOLDS ST, MC KENZIE, TN 38201-2051
(731) 358-4062
Mailing address
33 REYNOLDS ST, MC KENZIE, TN 38201-2051
(731) 358-4062
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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