| Organization Name: | STATE OF TENNESSEE |
| NPI Number: | 1316090145 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANNETTE HALEY (REGIONAL DIRECTOR) |
| Mailing Address: | 800 S Brown St Springfield |
| State: | TN US |
| Postal Code: | 371722920 |
| Phone Number: | 6153840208 |
| Fax Number: | 6153840245 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 08/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |