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General NPI Number Information
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NPI Number | 1144504291
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Entity Type | Organization
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Legal Business Name | SMOKEY MOUNTAIN ADULT CARE
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 216 PHOENIX CT
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City | SEYMOUR
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State | TN
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Zip | 37865-3914
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Country | US
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Telephone | 865-573-2678
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Fax |
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Provider Business Mailing Address
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Address Line | 216 PHOENIX CT
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City | SEYMOUR
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State | TN
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Zip | 37865-3914
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Country | US
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Telephone | 865-573-2678
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SONIA K CREWS-FOSTER
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Credential |
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Telephone | 865-633-9469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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