Healthcare Provider Details

I. General information

NPI: 1548432008
Provider Name (Legal Business Name): ATKINSON FAMILY DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 MAJORS BLVD
LYNCHBURG TN
37352-8391
US

IV. Provider business mailing address

526 MAJORS BLVD
LYNCHBURG TN
37352-8391
US

V. Phone/Fax

Practice location:
  • Phone: 931-759-7373
  • Fax:
Mailing address:
  • Phone: 931-759-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7905
License Number StateTN

VIII. Authorized Official

Name: VINCENT BRADLEY ATKINSON
Title or Position: PRESIDENT
Credential:
Phone: 931-759-7373