Healthcare Provider Details

I. General information

NPI: 1043533433
Provider Name (Legal Business Name): MRS. TOMECIA L SLADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MEMORIAL CIR
CLARKSVILLE TN
37043-4539
US

IV. Provider business mailing address

444 CUNNINGHAM LN
CLARKSVILLE TN
37042
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7333
  • Fax: 931-920-7332
Mailing address:
  • Phone: 931-503-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: