Healthcare Provider Details

I. General information

NPI: 1447530480
Provider Name (Legal Business Name): PROVIDE LOCUMS HEALTHCARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PEABODY ST
NASHVILLE TN
37210-2125
US

IV. Provider business mailing address

41 PEABODY ST
NASHVILLE TN
37210-2125
US

V. Phone/Fax

Practice location:
  • Phone: 423-426-4188
  • Fax:
Mailing address:
  • Phone: 423-426-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number30027
License Number StateAL

VIII. Authorized Official

Name: DR. PETER LITCHFIELD
Title or Position: MGR
Credential: MD
Phone: 423-426-4188