Healthcare Provider Details

I. General information

NPI: 1649226606
Provider Name (Legal Business Name): AMBULATORY AND OCCUPATIONAL HEALTH CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WILMA RUDOLPH BLVD
CLARKSVILLE TN
37040-5821
US

IV. Provider business mailing address

2320 WILMA RUDOLPH BLVD
CLARKSVILLE TN
37040-5821
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-1564
  • Fax: 931-645-3842
Mailing address:
  • Phone: 931-645-1564
  • Fax: 931-645-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN W KENT
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 931-645-1564