Provider Demographics
NPI:1992824163
Name:AUDREY KAREN TOLBERT
Entity Type:Organization
Organization Name:AUDREY KAREN TOLBERT
Other - Org Name:IMAC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-2300
Mailing Address - Street 1:345 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2331
Mailing Address - Country:US
Mailing Address - Phone:931-528-2300
Mailing Address - Fax:931-528-2305
Practice Address - Street 1:345 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2331
Practice Address - Country:US
Practice Address - Phone:931-528-2300
Practice Address - Fax:931-528-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715929Medicaid
TN3715929Medicare PIN