Organization Name: | YOUR GOOD HEALTH, LLC |
NPI Number: | 1386864296 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAURIE DAVIS (NURSE PRACTITIONER) |
Mailing Address: | 1508 Tombras Ave East Ridge |
State: | TN US |
Postal Code: | 374122720 |
Phone Number: | 4238674969 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 08/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | APN0000007173 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |