Individual
DR. SARAH MOON THELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
305 COLLEGE ST W, FAYETTEVILLE, TN 37334-2911
(931) 227-4984
(931) 227-4985
Mailing address
PO BOX 38, FAYETTEVILLE, TN 37334-0038
(931) 227-4984
(931) 227-4985
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD46417
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103G700423
MEDICARE GROUP
TN
05
—
1522807
—
TN
01
—
4293092
BLUE CROSS BLUE SHIELD TENNESSEE
TN
Enumeration date
03/26/2008
Last updated
06/09/2022
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