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General NPI Number Information
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NPI Number | 1992047120
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Entity Type | Organization
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Legal Business Name | LIFESPRINGS WOMENS HEALTHCARE, LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 627 MIDDLE CREEK RD
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5014
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Country | US
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Telephone | 865-365-4233
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Fax | 865-365-4234
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Provider Business Mailing Address
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Address Line | 627 MIDDLE CREEK RD
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5014
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Country | US
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Telephone | 865-365-4233
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Fax | 865-365-4234
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Authorized Official
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Title or Position | PRACTITIONER/OWNER
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Name | DR. JENNIFER ANDERSON MADDRON
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Credential | M.D.
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Telephone | 865-355-4233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 43185
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License Number State | TN
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