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General NPI Number Information
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NPI Number | 1518153469
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Entity Type | Organization
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Legal Business Name | SULLIVAN COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 3411 HIGHWAY 126 STE 202
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-4564
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Country | US
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Telephone | 423-354-1043
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Fax |
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Provider Business Mailing Address
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Address Line | 3411 HIGHWAY 126 STE 202
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-4564
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Country | US
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Telephone | 423-354-1043
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Fax |
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Authorized Official
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Title or Position | SCHOOL NURSE
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Name | DEBRA DICKENS
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Credential | RNBSN
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Telephone | 423-354-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 128167
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License Number State | TN
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