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General NPI Number Information
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NPI Number | 1386123222
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Entity Type | Organization
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Legal Business Name | NOTLOB ENTERPRISES
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Dates
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Enumeration Date | 08/11/2018
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 260 W 5TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1754
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Country | US
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Telephone | 931-432-5849
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Fax | 931-400-0489
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Provider Business Mailing Address
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Address Line | 3624 LONG LANE RD
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City | COOKEVILLE
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State | TN
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Zip | 38506-8012
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Country | US
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Telephone | 214-876-1248
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Fax | 931-432-4481
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. JAMES WADE BOLTON
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Credential | DC, APRN, FNP-C
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Telephone | 931-432-5849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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