Healthcare Provider Details

I. General information

NPI: 1174152011
Provider Name (Legal Business Name): BETTER LIFE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 FOREST DR STE 6
GRAY TN
37615-8422
US

IV. Provider business mailing address

1326 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-3142
  • Fax: 423-794-3184
Mailing address:
  • Phone: 865-219-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARET W TIPTON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 865-243-2136