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General NPI Number Information
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NPI Number | 1780686436
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TENNESSEE
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 294 SUMMAR DR
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City | JACKSON
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State | TN
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Zip | 38301-3915
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Country | US
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Telephone | 731-423-1932
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Fax | 731-423-4919
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Provider Business Mailing Address
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Address Line | 294 SUMMAR DR DEPT. 289
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City | JACKSON
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State | TN
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Zip | 38301-3915
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Country | US
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Telephone | 731-265-8220
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Fax | 731-265-8355
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Authorized Official
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Title or Position | MANAGER
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Name | JOAN L PORTER
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Credential |
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Telephone | 731-265-8220
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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 | TN
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