MEDICARE: TAILWATER PRACTICE PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366312027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAILWATER PRACTICE PARTNERS

Provider Business Mailing Address
First Line	:	10 BURTON HILLS BLVD STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3004
Country	:	US
Telephone Number	:	912-270-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 N MAIN ST
Second Line	:
City	:	MT PLEASANT
State	:	TN
Zip	:	38474-1015
Country	:	US
Telephone Number	:	931-379-7711
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLES MANAGER
Name	:	HILLARY HARRIS
Credential	:
Telephone Number	:	912-270-0920

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	12/11/2025

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