Healthcare Provider Details

I. General information

NPI: 1346420924
Provider Name (Legal Business Name): SUSAN N PICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 LANTANA RD
CROSSVILLE TN
38555-4946
US

IV. Provider business mailing address

PO BOX 568
CROSSVILLE TN
38557-0568
US

V. Phone/Fax

Practice location:
  • Phone: 931-707-8383
  • Fax: 931-707-1076
Mailing address:
  • Phone: 931-707-8383
  • Fax: 931-707-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number023765
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number023765
License Number StateTN

VIII. Authorized Official

Name: MRS. SUSAN N. PICK
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 931-707-8383