=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932523388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH HEROES OF TENNESSEE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2014
-----------------------------------------------------
Last Update Date | 06/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 BEDFORD WAY
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-609-0268
-----------------------------------------------------
Fax | 866-737-9625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 PRAIRIE STREET NORTH
-----------------------------------------------------
City | UNION SPRINGS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36089-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-609-0268
-----------------------------------------------------
Fax | 866-737-9625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. LIBERTY DUKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-220-2484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | MD0000040964
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD000040964
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------