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General NPI Number Information
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NPI Number | 1578881132
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Entity Type | Organization
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Legal Business Name | LOUDON COUNTY PEDIATRICS, PC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 423 MEDICAL PARK DR
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City | LENOIR CITY
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State | TN
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Zip | 37772-5640
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Country | US
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Telephone | 865-986-9233
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Fax | 865-986-0148
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Provider Business Mailing Address
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Address Line | 423 MEDICAL PARK DR
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City | LENOIR CITY
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State | TN
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Zip | 37772-5640
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Country | US
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Telephone | 865-986-9233
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Fax | 865-986-0148
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | DWIGHT DANIEL BIVENS
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Credential |
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Telephone | 865-986-9233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 145961
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License Number State | TN
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