Organization · Type 2 NPI

State of Tennessee

Public Health or Welfare Agency · Jackson, TN

NPI number 1114222379 Active

Practice location

295 Summar Drive
Jackson, TN 38301

Call (731) 421-6700 Map

Fax (731) 935-7093

Specialties and licenses

TaxonomyCodeLicense
Public Health or Welfare Agency Primary 251K00000XNone listed

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About NPI 1114222379

State of Tennessee's National Provider Identifier is 1114222379, issued on Jan 20, 2011. The primary taxonomy on file is Public Health or Welfare Agency (251K00000X), and the practice location is in Jackson, TN. The record was last updated on Dec 29, 2011.