=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548432008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATKINSON FAMILY DENTISTRY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 03/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 526 MAJORS BLVD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37352-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-759-7373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 526 MAJORS BLVD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37352-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-759-7373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VINCENT BRADLEY ATKINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 931-759-7373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7905
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------