Healthcare Provider Details

I. General information

NPI: 1548757677
Provider Name (Legal Business Name): ACHIEVE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 04/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 LEBANON PIKE
HERMITAGE TN
37076-2006
US

IV. Provider business mailing address

3432 LEBANON PIKE
HERMITAGE TN
37076-2006
US

V. Phone/Fax

Practice location:
  • Phone: 615-878-3423
  • Fax:
Mailing address:
  • Phone: 615-878-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY A HENEGAR
Title or Position: CRENDITALING SPECIALIST
Credential:
Phone: 423-341-2570