Healthcare Provider Details

I. General information

NPI: 1447341441
Provider Name (Legal Business Name): EUNICE GUDGER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 OLD HIGHWAY 64
BOLIVAR TN
38008-3587
US

IV. Provider business mailing address

10710 OLD HIGHWAY 64
BOLIVAR TN
38008-3587
US

V. Phone/Fax

Practice location:
  • Phone: 731-658-6113
  • Fax: 731-658-6165
Mailing address:
  • Phone: 731-658-6113
  • Fax: 731-658-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: