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General NPI Number Information
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NPI Number | 1710535703
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Entity Type | Organization
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Legal Business Name | PERRY COUNTY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 7723 CLEARVIEW CHURCH LN STE 200
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City | LYLES
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State | TN
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Zip | 37098-1674
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Country | US
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Telephone | 931-670-8318
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 916
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City | LINDEN
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State | TN
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Zip | 37096-0916
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Country | US
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Telephone | 931-589-2104
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PHILLIP BRADLEY TATUM
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Credential |
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Telephone | 931-589-2104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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