Healthcare Provider Details

I. General information

NPI: 1114040292
Provider Name (Legal Business Name): THOMAS J MABRY & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N GRUNDY QUARLES HWY
GAINESBORO TN
38562
US

IV. Provider business mailing address

PO BOX 7 1340 N GRUNDY QUARLES HIGHWAY
GAINESBORO TN
38562
US

V. Phone/Fax

Practice location:
  • Phone: 931-268-0291
  • Fax: 931-268-9241
Mailing address:
  • Phone: 931-268-0291
  • Fax: 931-268-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000136
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000000136
License Number StateTN

VIII. Authorized Official

Name: DIANA REICH
Title or Position: CFO
Credential:
Phone: 931-268-0291