Provider Demographics
NPI:1932137585
Name:CHURCH, DEBI A (CPM-TN)
Entity Type:Individual
Prefix:MRS
First Name:DEBI
Middle Name:A
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CPM-TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 COUNTY ROAD 654
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-6210
Mailing Address - Country:US
Mailing Address - Phone:423-745-5163
Mailing Address - Fax:423-507-8099
Practice Address - Street 1:148 COUNTY ROAD 654
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-6210
Practice Address - Country:US
Practice Address - Phone:423-745-5163
Practice Address - Fax:423-507-8099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000009176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife