Organization Name: | ALLERGY TREATMENT AND DIAGNOSTIC CENTER, LLC |
NPI Number: | 1407247935 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHERYL WRIGHT (ORGANIZER) |
Mailing Address: | 130 E Locust St Dresden |
State: | TN US |
Postal Code: | 382251467 |
Phone Number: | 7312858247 |
Fax Number: | 7313345732 |
NPI Enumeration Date: | 02/05/2015 |
NPI Last Update Date: | 02/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 16412 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |