Organization
PREMIER CHILDRENS HEALTHCARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS STACY KELLUM (OFFICE MANAGER)
(615) 453-9492
Entity
Organization
Contact information
Practice address
1029 WEST MAIN ST, SUITE M, LEBANON, TN 37087
(615) 453-9492
(615) 453-9498
Mailing address
1029 WEST MAIN ST, SUITE M, LEBANON, TN 37087
(615) 453-9492
(615) 453-9498
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
09/22/2006
Last updated
04/08/2010
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