Provider Demographics
NPI:1982759890
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:HAWKINS COUNTY HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-272-7641
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0488
Mailing Address - Country:US
Mailing Address - Phone:423-272-7641
Mailing Address - Fax:423-921-8073
Practice Address - Street 1:201 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2919
Practice Address - Country:US
Practice Address - Phone:423-272-7641
Practice Address - Fax:423-921-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3911418Medicare PIN