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General NPI Number Information
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NPI Number | 1255139291
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Entity Type | Organization
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Legal Business Name | TAILWATER PRACTICE PARTNERS
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 99 SIGNATURE PL
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City | LEBANON
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State | TN
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Zip | 37087-3285
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Country | US
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Telephone | 615-444-2034
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Fax |
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Provider Business Mailing Address
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Address Line | 619 GALLANT WAY
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City | MURFREESBORO
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State | TN
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Zip | 37129-4267
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Country | US
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Telephone | 912-270-0920
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Fax |
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Authorized Official
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Title or Position | RCM MANAGER
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Name | HILLARY HARRIS
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Credential |
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Telephone | 912-270-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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