Healthcare Provider Details

I. General information

NPI: 1225307747
Provider Name (Legal Business Name): MISS TAYLOR LEIS DUNNINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 UNION ST
CLARKSVILLE TN
37040-5115
US

IV. Provider business mailing address

1751 ASHLAND CITY RD APT J79
CLARKSVILLE TN
37043-4857
US

V. Phone/Fax

Practice location:
  • Phone: 931-647-8257
  • Fax:
Mailing address:
  • Phone: 931-797-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: