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General NPI Number Information
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NPI Number | 1811798481
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Entity Type | Organization
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Legal Business Name | WILLOW PEDIATRIC CLINIC, LLC
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1400 WILLOW DR
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City | MANCHESTER
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State | TN
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Zip | 37355-2438
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Country | US
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Telephone | 931-273-5685
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 66
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City | TULLAHOMA
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State | TN
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Zip | 37388-0066
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Country | US
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Telephone | 931-273-5685
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | REBECCA SWIGER
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Credential | DNP
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Telephone | 931-273-5682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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