Provider Demographics
NPI:1396377800
Name:RESTORATIVE FAMILY MEDICINE
Entity Type:Organization
Organization Name:RESTORATIVE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-616-0880
Mailing Address - Street 1:3773 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-6236
Mailing Address - Country:US
Mailing Address - Phone:423-616-0880
Mailing Address - Fax:423-616-0881
Practice Address - Street 1:3773 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-6236
Practice Address - Country:US
Practice Address - Phone:423-616-0880
Practice Address - Fax:423-616-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty