Healthcare Provider Details

I. General information

NPI: 1639694615
Provider Name (Legal Business Name): EVENTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W COURT SQ
LIVINGSTON TN
38570-1882
US

IV. Provider business mailing address

102 W COURT SQ
LIVINGSTON TN
38570-1882
US

V. Phone/Fax

Practice location:
  • Phone: 931-510-4932
  • Fax:
Mailing address:
  • Phone: 931-510-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GANTT
Title or Position: COO
Credential:
Phone: 931-510-4932