Provider Demographics
NPI:1396037339
Name:ATLAS OSTEOPATHY LLC
Entity Type:Organization
Organization Name:ATLAS OSTEOPATHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-854-9393
Mailing Address - Street 1:404 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2339
Mailing Address - Country:US
Mailing Address - Phone:931-854-9393
Mailing Address - Fax:931-233-2449
Practice Address - Street 1:404 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-854-9393
Practice Address - Fax:931-233-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1785208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty