Organization
ATOKA IDAVILLE FAMILY HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN YVETTE VANDERFORD FNP (OWNER/PROVIDER)
(901) 837-0701
Entity
Organization
Contact information
Practice address
5847 ATOKA IDAVILLE RD, BRIGHTON, TN 38011-7066
(901) 304-8709
Mailing address
5847 ATOKA IDAVILLE RD, BRIGHTON, TN 38011-7066
(901) 837-0701
(901) 837-0703
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
13123
TN
363LF0000X
Family Nurse Practitioner
2007009643
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3703407
—
TN
Enumeration date
02/13/2016
Last updated
09/30/2022
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