Provider Demographics
NPI:1477858256
Name:OWEN, EFE K
Entity Type:Individual
Prefix:MR
First Name:EFE
Middle Name:K
Last Name:OWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1131
Mailing Address - Country:US
Mailing Address - Phone:615-403-2916
Mailing Address - Fax:615-731-8944
Practice Address - Street 1:4340 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1131
Practice Address - Country:US
Practice Address - Phone:615-403-2916
Practice Address - Fax:615-717-6900
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN089700663347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle