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General NPI Number Information
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NPI Number | 1104869486
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Entity Type | Organization
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Legal Business Name | STATE OF TENNESSEE STATE F & A PAYROLL
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 100 MOCCASIN BEND RD
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City | CHATTANOOGA
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State | TN
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Zip | 37405-4415
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Country | US
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Telephone | 423-785-3321
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Fax | 423-785-3454
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Provider Business Mailing Address
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Address Line | 100 MOCCASIN BEND RD
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City | CHATTANOOGA
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State | TN
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Zip | 37405-4415
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Country | US
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Telephone | 423-785-3321
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Fax | 423-785-3454
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Authorized Official
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Title or Position | CHIEF OF PHARMACY
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Name | JASON CARTER
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Credential |
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Telephone | 615-532-6736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | L2(16)M21051098
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License Number State | TN
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