Provider Demographics
NPI:1235455304
Name:SINGLETON FAMILY PRACTICE & WEIGHT LOSS CLINIC, LLC
Entity Type:Organization
Organization Name:SINGLETON FAMILY PRACTICE & WEIGHT LOSS CLINIC, LLC
Other - Org Name:SINGLETON FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-859-8081
Mailing Address - Street 1:238 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2227
Mailing Address - Country:US
Mailing Address - Phone:615-859-8081
Mailing Address - Fax:615-859-8082
Practice Address - Street 1:430 LONG HOLLOW PIKE
Practice Address - Street 2:E
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3480
Practice Address - Country:US
Practice Address - Phone:615-859-8081
Practice Address - Fax:615-859-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1073500377Medicare PIN