Facts
- Status
- A
- Credential
- LMT
- Type
- Individual
- Enumeration date
- 2013-03-08
- Last updated
- 2013-03-08
Specialties
Licenses
- License TN
- MT9447
Location
- Practice location
- 1660 ALLEN RD
- City
- TALBOTT TN
- Postal code
- 378779075
- Phone
- 423-839-0773
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.