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General NPI Number Information
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NPI Number | 1871483743
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Entity Type | Organization
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Legal Business Name | ABUNDANT HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 2145 OLD ASHLAND CITY RD
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City | CLARKSVILLE
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State | TN
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Zip | 37043-4906
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Country | US
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Telephone | 931-346-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 1497 HOLLIS RDG
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City | CLARKSVILLE
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State | TN
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Zip | 37043-1522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MATT SMITH
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Credential |
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Telephone | 731-618-7179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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