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9160 Highway 64 Suite 5 Lakeland TN 38002-4766 | |
(901) 623-3587 | |
(901) 213-9235 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 9160 Highway 64, Lakeland, Tennessee |
Authorized Official Name and Position | Oliver Banks (OFFICE MANAGER) |
Authorized Official Contact | 9014971040 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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9160 Highway 64 Suite 5 Lakeland TN 38002-4766 Ph: (901) 623-3587 | 9160 Highway 64 Suite 5 Lakeland TN 38002-4766 Ph: (901) 623-3587 |
NPI Number | 1356893226 |
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Provider Enumeration Date | 10/26/2016 |
Last Update Date | 10/26/2016 |
Identifier | Type | State | Issuer |
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1356893226 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | MD0000006816 (Tennessee) | Primary |