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General NPI Number Information
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NPI Number | 1194066472
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Entity Type | Organization
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Legal Business Name | INNOVA MEDICAL PLLC
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 740 COOL SPRINGS BLVD SUITE 120
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City | FRANKLIN
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State | TN
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Zip | 37067-6448
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Country | US
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Telephone | 615-550-6097
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Fax |
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Provider Business Mailing Address
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Address Line | 1989 BRISBANE DR
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City | SPRING HILL
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State | TN
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Zip | 37174-8575
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY ANTHONY MICELI JR.
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Credential | DC
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Telephone | 615-414-8459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD31405
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License Number State | TN
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