Provider Demographics
NPI:1760745269
Name:TRINITY DIABETES AND ENDOCRINE CLINIC,P.C.
Entity Type:Organization
Organization Name:TRINITY DIABETES AND ENDOCRINE CLINIC,P.C.
Other - Org Name:ERNEST K. ANTWI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANTWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-421-8908
Mailing Address - Street 1:2782 N HIGHLAND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1797
Mailing Address - Country:US
Mailing Address - Phone:731-421-8908
Mailing Address - Fax:731-421-8469
Practice Address - Street 1:2782 N HIGHLAND AVE STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1797
Practice Address - Country:US
Practice Address - Phone:731-421-8908
Practice Address - Fax:731-421-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty