Organization Name: | TLC MEDICAL CLINIC INC |
NPI Number: | 1083916563 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LADONNA MARIE LEDFORD (NURSE PRACTITIONER) |
Mailing Address: | 215 S Anderson St Tullahoma |
State: | TN US |
Postal Code: | 373883735 |
Phone Number: | 9315637464 |
Fax Number: | 9315637401 |
NPI Enumeration Date: | 12/03/2010 |
NPI Last Update Date: | 08/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 8441 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |