Provider Demographics
NPI:1235548504
Name:DIVERSE MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:DIVERSE MEDICAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-815-8525
Mailing Address - Street 1:82 BECKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-5006
Mailing Address - Country:US
Mailing Address - Phone:931-409-4350
Mailing Address - Fax:
Practice Address - Street 1:82 BECKRIDGE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-5006
Practice Address - Country:US
Practice Address - Phone:931-409-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4633104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007193Medicaid
AL207575Medicaid