Healthcare Provider Details

I. General information

NPI: 1750192233
Provider Name (Legal Business Name): FIRST PRESBYTERIAN CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MAIN ST
CLARKSVILLE TN
37040-3237
US

IV. Provider business mailing address

213 MAIN ST
CLARKSVILLE TN
37040-3237
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-6551
  • Fax:
Mailing address:
  • Phone: 931-645-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANN WADDLE
Title or Position: ADMINISTRATOR/VOLUNTEER
Credential: PH.D
Phone: 931-624-2597