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General NPI Number Information
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NPI Number | 1801301452
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Entity Type | Organization
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Legal Business Name | 4M HEALTHSYSTEM INC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 827 VIRTUE RD
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City | KNOXVILLE
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State | TN
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Zip | 37934-5344
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Country | US
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Telephone | 865-201-2705
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Fax | 865-201-2705
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Provider Business Mailing Address
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Address Line | 269 W HUNT RD
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City | ALCOA
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State | TN
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Zip | 37701-1724
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Country | US
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Telephone | 931-979-5158
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. JAMES ROBERT STUBBLEFIELD JR.
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Credential |
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Telephone | 931-979-5158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | LDC0000000580
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License Number State | TN
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