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General NPI Number Information
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NPI Number | 1518650001
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Entity Type | Organization
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Legal Business Name | SOUTHLAND HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 2036 CHILHOWEE MEDICAL PARK
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City | MARYVILLE
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State | TN
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Zip | 37804-5285
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Country | US
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Telephone | 865-406-2715
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Fax |
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Provider Business Mailing Address
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Address Line | 3834 JACKSON BEND DR
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City | LOUISVILLE
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State | TN
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Zip | 37777-3791
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. CLAY STALCUP
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Credential | MD
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Telephone | 865-406-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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