Provider Demographics
NPI:1437297330
Name:FLETCHER, ELIZABETH GWYNNE
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GWYNNE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:GWYNNE
Other - Last Name:MOWRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:RT 6 BOX 540
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251
Practice Address - Country:US
Practice Address - Phone:276-452-1144
Practice Address - Fax:276-452-1140
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator