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General NPI Number Information
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NPI Number | 1649034844
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Entity Type | Organization
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Legal Business Name | CLINIC
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 120 MAPLEWOOD TRCE
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City | NASHVILLE
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State | TN
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Zip | 37207-3019
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Country | US
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Telephone | 562-283-8803
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Fax |
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Provider Business Mailing Address
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Address Line | 123 ALLEN ST APT 15
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City | NEW YORK
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State | NY
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Zip | 10002-3054
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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 | CHAIRMAN
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Name | ZHOU FANG
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Credential |
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Telephone | 562-283-8803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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