Healthcare Provider Details

I. General information

NPI: 1609113224
Provider Name (Legal Business Name): MONTGOMERY COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 PAGEANT LN
CLARKSVILLE TN
37040-3854
US

IV. Provider business mailing address

330 PAGEANT LN
CLARKSVILLE TN
37040-3854
US

V. Phone/Fax

Practice location:
  • Phone: 931-648-5747
  • Fax:
Mailing address:
  • Phone: 931-648-5747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number0000115065
License Number StateTN

VIII. Authorized Official

Name: PAULETTE COWAN
Title or Position: HUMAN RESOURCES
Credential:
Phone: 615-650-7024