Provider Demographics
NPI:1063014363
Name:TENNESSEE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:TENNESSEE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-836-2532
Mailing Address - Street 1:315 N WASHINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2623
Mailing Address - Country:US
Mailing Address - Phone:931-651-1918
Mailing Address - Fax:931-651-1916
Practice Address - Street 1:315 N WASHINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2623
Practice Address - Country:US
Practice Address - Phone:931-651-1918
Practice Address - Fax:931-651-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center