Healthcare Provider Details

I. General information

NPI: 1407748395
Provider Name (Legal Business Name): DIABETES SPECIALITY CARE AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 HIGHWAY 66 S STE 5
ROGERSVILLE TN
37857-5197
US

IV. Provider business mailing address

3815 HIGHWAY 66 S STE 5
ROGERSVILLE TN
37857-5197
US

V. Phone/Fax

Practice location:
  • Phone: 423-293-0202
  • Fax:
Mailing address:
  • Phone: 423-293-0202
  • Fax: 423-293-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA ANNE REINERS
Title or Position: CREDENTIALING
Credential:
Phone: 731-571-9223