Healthcare Provider Details

I. General information

NPI: 1427448430
Provider Name (Legal Business Name): DIVINITY HEALTH DIAGNOSTICS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 ALLEY RD
ANDERSONVILLE TN
37705-3910
US

IV. Provider business mailing address

153 ALLEY RD
ANDERSONVILLE TN
37705-3910
US

V. Phone/Fax

Practice location:
  • Phone: 865-603-1738
  • Fax:
Mailing address:
  • Phone: 865-603-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTA TAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 865-603-1738