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General NPI Number Information
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NPI Number | 1154637122
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTHCARE OF CENTRAL TENNESSEE, PLLC
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 112 AIRPORT BUSINESS PARK DRIVE SUITE G
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City | SHELBYVILLE
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State | TN
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Zip | 37160
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Country | US
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Telephone | 931-735-6036
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Fax | 931-735-6293
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Provider Business Mailing Address
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Address Line | 112 AIRPORT BUSINESS PARK DRIVE SUITE G
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City | SHELBYVILLE
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State | TN
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Zip | 37160
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Country | US
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Telephone | 931-735-6036
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Fax | 931-735-6293
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Authorized Official
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Title or Position | OWNER
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Name | RONALD ANGLES
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Credential | D.O.
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Telephone | 931-735-6036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2139
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License Number State | TN
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