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General NPI Number Information
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NPI Number | 1801941539
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Entity Type | Organization
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Legal Business Name | RENAISSANCE HEALTH AND SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 325 S CEDAR AVE SUITE 2
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City | SOUTH PITTSBURG
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State | TN
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Zip | 37380-1305
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Country | US
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Telephone | 423-837-5801
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Fax | 423-837-5807
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Provider Business Mailing Address
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Address Line | 325 S CEDAR AVE SUITE 2
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City | SOUTH PITTSBURG
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State | TN
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Zip | 37380-1305
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Country | US
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Telephone | 423-837-5801
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Fax | 423-837-5807
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | BONNIE LYNN BREWER
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Credential |
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Telephone | 423-837-5801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 30628
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 30628
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License Number State | TN
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