| Organization Name: | STATE OF TENNESSEE |
| NPI Number: | 1720255631 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY MAYES (REGIONAL DIRECTOR) |
| Mailing Address: | Highway 126 Blountville |
| State: | TN US |
| Postal Code: | 37617 |
| Phone Number: | 4232792777 |
| Fax Number: | 4232792797 |
| NPI Enumeration Date: | 05/09/2008 |
| NPI Last Update Date: | 05/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |