Healthcare Provider Details

I. General information

NPI: 1437101573
Provider Name (Legal Business Name): TENNESSEE VALLEY SPECIALTY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E COLLEGE ST SUITE 7
PULASKI TN
38478-4500
US

IV. Provider business mailing address

1275 E COLLEGE ST SUITE 7
PULASKI TN
38478-4500
US

V. Phone/Fax

Practice location:
  • Phone: 931-363-2925
  • Fax: 931-363-9563
Mailing address:
  • Phone: 931-363-2925
  • Fax: 931-363-9563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FIRYAD HAKIM
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-363-2925