Provider Demographics
NPI:1710314513
Name:HEART OF TENNESSEE WELLNESS INC.
Entity Type:Organization
Organization Name:HEART OF TENNESSEE WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/MEDICAL ADVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-735-6300
Mailing Address - Street 1:745 S CHURCH ST
Mailing Address - Street 2:SUITE A 130
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4984
Mailing Address - Country:US
Mailing Address - Phone:931-735-6300
Mailing Address - Fax:931-735-6302
Practice Address - Street 1:745 S CHURCH ST
Practice Address - Street 2:SUITE A 130
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4984
Practice Address - Country:US
Practice Address - Phone:931-735-6300
Practice Address - Fax:931-735-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty