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General NPI Number Information
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NPI Number | 1659684256
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Entity Type | Organization
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Legal Business Name | LIFE LONG FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 204 HIGHWAY 52 BYP W
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City | LAFAYETTE
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State | TN
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Zip | 37083-1727
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Country | US
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Telephone | 615-688-7353
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Fax | 615-688-7355
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Provider Business Mailing Address
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Address Line | 3810 CENTRAL PIKE SUITE 201
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City | HERMITAGE
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State | TN
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Zip | 37076-3494
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Country | US
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Telephone | 615-871-0555
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Fax | 615-871-9398
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS K PARDUE
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Credential | M.D.
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Telephone | 615-871-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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