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General NPI Number Information
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NPI Number | 1093263055
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Entity Type | Organization
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Legal Business Name | TENNESSEE VASCULAR AND THORACIC SURGICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 315 NW ATLANTIC ST
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City | TULLAHOMA
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State | TN
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Zip | 37388
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Country | US
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Telephone | 931-841-3948
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Fax | 931-841-3906
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Provider Business Mailing Address
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Address Line | PO BOX 1958
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City | TULLAHOMA
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State | TN
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Zip | 37388-1958
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Country | US
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Telephone | 931-222-4090
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Fax | 931-222-4093
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES STITT DRUMMOND III
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Credential | MD
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Telephone | 931-841-3948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD39435
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License Number State | TN
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