Provider Demographics
NPI:1558701755
Name:BRENTWOOD FAMILY WELLNESS CLINIC
Entity Type:Organization
Organization Name:BRENTWOOD FAMILY WELLNESS CLINIC
Other - Org Name:NOLENSVILLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-776-2484
Mailing Address - Street 1:7175 NOLENSVILLE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9655
Mailing Address - Country:US
Mailing Address - Phone:615-776-2484
Mailing Address - Fax:
Practice Address - Street 1:7175 NOLENSVILLE ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135
Practice Address - Country:US
Practice Address - Phone:615-776-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty