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General NPI Number Information
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NPI Number | 1356448633
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Entity Type | Organization
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Legal Business Name | TN VALLEY
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 NEAL ST SUITE 101
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City | COOKEVILLE
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State | TN
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Zip | 38501-0901
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Country | US
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Telephone | 931-525-1651
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Fax | 931-525-2165
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Provider Business Mailing Address
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Address Line | PO BOX 3432
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City | COOKEVILLE
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State | TN
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Zip | 38502-3432
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Country | US
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Telephone | 931-525-1651
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Fax | 931-525-1653
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Authorized Official
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Title or Position | MD
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Name | DR. REXFORD AGBENOHEVI
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Credential | MD
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Telephone | 931-525-1651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 0000046089
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License Number State | TN
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