Provider Demographics
NPI:1275179301
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:731-421-6700
Mailing Address - Street 1:1250 S MANUFACTURERS ROW
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3632
Mailing Address - Country:US
Mailing Address - Phone:731-855-7601
Mailing Address - Fax:
Practice Address - Street 1:1250 S MANUFACTURERS ROW
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3632
Practice Address - Country:US
Practice Address - Phone:731-855-7601
Practice Address - Fax:731-855-7603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIBSON CO. HEALTH DEPT.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare