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General NPI Number Information
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NPI Number | 1053905927
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE OUTREACH OF TN
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1276 FOSTER AVE
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City | NASHVILLE
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State | TN
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Zip | 37210-4418
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Country | US
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Telephone | 615-983-1707
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Fax |
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Provider Business Mailing Address
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Address Line | 434 MONTICELLO ST
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City | NASHVILLE
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State | TN
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Zip | 37207-4300
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Country | US
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Telephone | 615-983-1707
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | AMANDA CRAWLEY
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Credential |
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Telephone | 619-983-1707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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