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General NPI Number Information
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NPI Number | 1538750286
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Entity Type | Organization
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Legal Business Name | T4T
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 104 W COURT AVE
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City | SELMER
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State | TN
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Zip | 38375-2102
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Country | US
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Telephone | 833-835-3436
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Fax |
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Provider Business Mailing Address
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Address Line | 38 SJ HICKERSON RD
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City | TRENTON
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State | TN
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Zip | 38382-9262
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Country | US
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Telephone | 815-354-7442
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TAMMY M GRIFFIS
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Credential | NP
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Telephone | 815-354-7442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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