Healthcare Provider Details

I. General information

NPI: 1992047120
Provider Name (Legal Business Name): LIFESPRINGS WOMENS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 MIDDLE CREEK RD
SEVIERVILLE TN
37862-5014
US

IV. Provider business mailing address

627 MIDDLE CREEK RD
SEVIERVILLE TN
37862-5014
US

V. Phone/Fax

Practice location:
  • Phone: 865-365-4233
  • Fax: 865-365-4234
Mailing address:
  • Phone: 865-365-4233
  • Fax: 865-365-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43185
License Number StateTN

VIII. Authorized Official

Name: DR. JENNIFER ANDERSON MADDRON
Title or Position: PRACTITIONER/OWNER
Credential: M.D.
Phone: 865-355-4233