Provider Demographics
NPI:1790528354
Name:TWELVESTONE MEDICAL, INC
Entity type:Organization
Organization Name:TWELVESTONE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT, SECRETARY, AO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:615-278-3146
Mailing Address - Street 1:PO BOX 12369
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0048
Mailing Address - Country:US
Mailing Address - Phone:615-278-3278
Mailing Address - Fax:615-278-3355
Practice Address - Street 1:3500 LOOP RD STE B4
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3133
Practice Address - Country:US
Practice Address - Phone:844-893-0012
Practice Address - Fax:615-278-3355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWELVESTONE MEDICAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHHH000083OtherGA BOP