=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497721609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHWAYS OF TENNESSEE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 238 SUMMAR DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38301-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-541-8200
-----------------------------------------------------
Fax | 731-541-8327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 238 SUMMAR DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38301-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-541-8200
-----------------------------------------------------
Fax | 731-541-8327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | MS. TINA PRESCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 731-541-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 0000000249
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------