Healthcare Provider Details

I. General information

NPI: 1790718898
Provider Name (Legal Business Name): RIVER CITY CONVENIENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 PICKWICK ST
SAVANNAH TN
38372-5309
US

IV. Provider business mailing address

1960 PICKWICK ST
SAVANNAH TN
38372-5309
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-1911
  • Fax: 731-925-1912
Mailing address:
  • Phone: 731-925-1911
  • Fax: 731-925-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1611
License Number StateTN

VIII. Authorized Official

Name: DR. RENA DELL SALYER
Title or Position: DOCTOR
Credential: D.O.
Phone: 731-925-1911