Healthcare Provider Details

I. General information

NPI: 1255867933
Provider Name (Legal Business Name): TULLAHOMA WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 KINGS LN
TULLAHOMA TN
37388-5372
US

IV. Provider business mailing address

707 KINGS LN
TULLAHOMA TN
37388-5372
US

V. Phone/Fax

Practice location:
  • Phone: 931-393-3484
  • Fax: 931-461-1171
Mailing address:
  • Phone: 931-393-3484
  • Fax: 931-461-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD MATHER BENNETT
Title or Position: OWNER
Credential: MD
Phone: 931-434-4068