Provider Demographics
NPI:1689978561
Name:TENNESSEE DEPT OF HEALTH
Entity Type:Organization
Organization Name:TENNESSEE DEPT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-735-0242
Mailing Address - Street 1:251 JOY ALFORD WAY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-3047
Mailing Address - Country:US
Mailing Address - Phone:615-735-0242
Mailing Address - Fax:615-735-8250
Practice Address - Street 1:251 JOY ALFORD WAY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-3047
Practice Address - Country:US
Practice Address - Phone:615-735-0242
Practice Address - Fax:615-735-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN137324261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local