Organization
SIGNATURE MEDICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL D TIDWELL (PRESIDENT)
(615) 758-4601
Entity
Organization
Contact information
Practice address
1097 WESTON DR, SUITE 1, MOUNT JULIET, TN 37122-3493
(615) 758-4601
(615) 754-7074
Mailing address
201 SIGNATURE PL, SUITE 104, LEBANON, TN 37087-3376
(615) 444-7999
(615) 444-7765
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
12/01/2009
Last updated
03/10/2010
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