National Provider Identifier Database

ATOKA IDAVILLE FAMILY HEALTH INC
Primary Care


Contact Information

ATOKA IDAVILLE FAMILY HEALTH, INC
5847 ATOKA IDAVILLE RD
BRIGHTON, TN38011-7066
Phone: 901-304-8709
Fax:
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X
Family 363LF0000X

* Indicates primary specialty

NPI Profile & details for ATOKA IDAVILLE FAMILY HEALTH, INC

NPI Number 1962861310
Legal business name
LBN
ATOKA IDAVILLE FAMILY HEALTH, INC
Authorized official ROBYN VANDERFORD - (OWNER/PROVIDER)
Entity Organization
Organization subpart No
Enumeration date 02/13/2016
Last updated 09/30/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers
  • TN License #: 13123
  • TN License #: 2007009643
  • TN Medicaid: 3703407

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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