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General NPI Number Information
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NPI Number | 1871643031
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Entity Type | Organization
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Legal Business Name | STATE OF TENNESSEE
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 400 HWY 78 SOUTH
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City | TIPTONVILLE
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State | TN
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Zip | 38079
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Country | US
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Telephone | 731-253-9954
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Fax | 731-253-9956
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Provider Business Mailing Address
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Address Line | 400 HWY 78 SOUTH
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City | TIPTONVILLE
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State | TN
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Zip | 38079
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Country | US
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Telephone | 731-253-9954
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Fax | 731-253-9956
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | MR. ANTHONY W HARDEN
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Credential |
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Telephone | 731-421-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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