Provider Demographics
NPI:1255139291
Name:TAILWATER PRACTICE PARTNERS
Entity type:Organization
Organization Name:TAILWATER PRACTICE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-270-0920
Mailing Address - Street 1:619 GALLANT WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-4267
Mailing Address - Country:US
Mailing Address - Phone:912-270-0920
Mailing Address - Fax:
Practice Address - Street 1:99 SIGNATURE PL
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3285
Practice Address - Country:US
Practice Address - Phone:615-444-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAILWATER PRACTICE PARTNERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty