ATOKA IDAVILLE FAMILY HEALTH, INC; NPI #1962861310

Contact Information

ATOKA IDAVILLE FAMILY HEALTH, INC

5847 ATOKA IDAVILLE RD
BRIGHTON, TN 38011-7066

Phone: 901-304-8709
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Primary Care	261QP2300X
Family	363LF0000X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for ATOKA IDAVILLE FAMILY HEALTH, INC

NPI Number 1962861310

LBN Legal business name ATOKA IDAVILLE FAMILY HEALTH, INC

Authorized official ROBYN VANDERFORD - (OWNER/PROVIDER)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/13/2016

Last updated 09/30/2022 - About 4 years ago

Identifiers

TN	License #	13123
TN	License #	2007009643
TN	Medicaid	3703407

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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ATOKA IDAVILLE FAMILY HEALTH, INC

Contact Information

Specialty

Primary Care

Family

NPI Profile & details for ATOKA IDAVILLE FAMILY HEALTH, INC

Reviews for ATOKA IDAVILLE FAMILY HEALTH, INC