Healthcare Provider Details

I. General information

NPI: 1265588651
Provider Name (Legal Business Name): ALICE R WARE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 N GATEWAY AVE
ROCKWOOD TN
37854-4108
US

IV. Provider business mailing address

1328 WARE FARMS RD
SPRING CITY TN
37381-4788
US

V. Phone/Fax

Practice location:
  • Phone: 865-354-1220
  • Fax: 865-354-0112
Mailing address:
  • Phone: 423-452-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number374525
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: