=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174284327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA D LOWDERMILK LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2022
-----------------------------------------------------
Last Update Date | 01/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1014 SOUTH CHANCERY ST
-----------------------------------------------------
City | MCMINNVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-474-7700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2660
-----------------------------------------------------
City | DUNLAP
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-619-5999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10716
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------