| Organization Name: | STATE OF TENNESSEE |
| NPI Number: | 1730230558 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONALD W. GRISHAM (HEALTH OFFICER / MEDICAL DIRECTOR) |
| Mailing Address: | 1013 Woodlawn Dr Byrdstown |
| State: | TN US |
| Postal Code: | 385492317 |
| Phone Number: | 9318643178 |
| Fax Number: | 9318643376 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 08/21/2014 |
| 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: | |