ATOKA IDAVILLE FAMILY HEALTH INC NPI 1962861310

NPI Information

NPI: 1962861310
Provider Name: ATOKA IDAVILLE FAMILY HEALTH, INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
5847 ATOKA IDAVILLE RD
BRIGHTON, TN
ZIP 38011
Phone: (901) 304-8709
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ATOKA IDAVILLE FAMILY HEALTH, INC is a primary care clinic center in Brighton, TN. ATOKA IDAVILLE FAMILY HEALTH, INC NPI is 1962861310. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5847 ATOKA IDAVILLE RD
BRIGHTON, TN
ZIP 38011-066
Phone: (901) 304-8709

The provider's authorized official is Robyn Yvette Vanderford .
The authorized official title is Owner/provider and has the following contact phone number (901) 837-0701.

The enumeration date for this NPI number is 2/13/2016 and was last updated on 9/30/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	2007009643	TENNESSEE	No
2	261QP2300X	Clinic/Center	Primary Care	13123	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3703407	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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