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General NPI Number Information
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NPI Number | 1992160212
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Entity Type | Organization
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Legal Business Name | MODERN AIDS INC
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 216 PHOENIX CT STE C
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City | SEYMOUR
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State | TN
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Zip | 37865-3914
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Country | US
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Telephone | 865-577-3500
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Fax | 865-577-3311
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Provider Business Mailing Address
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Address Line | 216 PHOENIX CT STE C
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City | SEYMOUR
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State | TN
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Zip | 37865
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Country | US
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Telephone | 865-577-3500
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Fax | 865-577-3311
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Authorized Official
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Title or Position | OWNER
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Name | JOHN A DAVIS
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Credential | A.C.A, BC-HIS
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Telephone | 865-577-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 789
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 660
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License Number State | TN
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