Healthcare Provider Details

I. General information

NPI: 1457638066
Provider Name (Legal Business Name): SARAH BROOKS LUMPKIN WYATT BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLSTON DR
GREENEVILLE TN
37743-3127
US

IV. Provider business mailing address

1167 SPRATLIN PARK DR
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-1104
  • Fax: 423-467-3644
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: