Healthcare Provider Details

I. General information

NPI: 1821412362
Provider Name (Legal Business Name): PROCTOR LOGIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MIDWOOD ST APT 3106
FRANKLIN TN
37067-6626
US

IV. Provider business mailing address

3000 MIDWOOD ST 3106
FRANKLIN TN
37067
US

V. Phone/Fax

Practice location:
  • Phone: 901-482-6033
  • Fax:
Mailing address:
  • Phone: 901-482-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number695393
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number695393
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number069639461
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: JABBAR LUMUMBA SMITH
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 901-482-6033