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General NPI Number Information
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NPI Number | 1801150362
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Entity Type | Organization
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Legal Business Name | TN RIVER MEDICINE, INC
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 259 N PETERS RD STE 103
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City | KNOXVILLE
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State | TN
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Zip | 37923-4923
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Country | US
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Telephone | 865-690-1255
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Fax | 865-690-4583
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Provider Business Mailing Address
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Address Line | 259 N PETERS RD STE 103
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City | KNOXVILLE
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State | TN
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Zip | 37923-4923
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Country | US
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Telephone | 865-690-1255
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Fax | 865-690-4583
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Authorized Official
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Title or Position | DIRECTOR
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Name | TINA L. SMITH
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Credential |
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Telephone | 865-690-1255
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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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