Doctor Name: | KELLY LANE DENNIS |
NPI Number: | 1205075421 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CXT0000000596 |
Business Practice Address: | 2425 Chester Harris Rd Woodlawn, TN - 371919054 |
Business Phone Number: | 9315528964 |
Business Fax Number: | |
Mailing Address: | 2425 Chester Harris Rd, WOODLAWN |
State: | TN |
Postal Code: | 371919054 |
Phone Number: | 9315528964 |
Fax Number: | |
NPI Enumeration Date: | 02/11/2009 |
NPI Last Update Date: | 02/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2471C3402X |
License Number: | CXT0000000596 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | Radiography |
Taxonomy Definition: |