Healthcare Provider Details

I. General information

NPI: 1497721609
Provider Name (Legal Business Name): PATHWAYS OF TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 SUMMAR DR
JACKSON TN
38301-3906
US

IV. Provider business mailing address

238 SUMMAR DR
JACKSON TN
38301-3906
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-8200
  • Fax: 731-541-8327
Mailing address:
  • Phone: 731-541-8200
  • Fax: 731-541-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0000000249
License Number StateTN

VIII. Authorized Official

Name: MS. TINA PRESCOTT
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 731-541-5000