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General NPI Number Information
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NPI Number | 1750942363
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Entity Type | Organization
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Legal Business Name | FAYETTE EYE ASSOCIATES PLLC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 3161 HIGHWAY 64 STE 500
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City | EADS
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State | TN
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Zip | 38028-3370
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Country | US
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Telephone | 901-465-3130
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Fax | 901-234-0133
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Provider Business Mailing Address
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Address Line | 3161 HIGHWAY 64 STE 500
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City | EADS
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State | TN
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Zip | 38028-3370
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Country | US
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Telephone | 901-465-3130
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Fax | 901-234-0133
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Authorized Official
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Title or Position | CREDENTIALING AND CONTRACTING
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Name | SHEILA S HOWELL
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Credential |
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Telephone | 901-757-2020
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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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