1144535071 NPI number — MRS. LORA REMONIA WILLIFORD RPT

Table of content: MRS. LORA REMONIA WILLIFORD RPT (NPI 1144535071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144535071 NPI number — MRS. LORA REMONIA WILLIFORD RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIFORD
Provider First Name:
LORA
Provider Middle Name:
REMONIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIFORD
Provider Other First Name:
LORA
Provider Other Middle Name:
REMONIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PRT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144535071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9746 NORTHFORK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-8333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-776-3773
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8044 COLEY DAVIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37221-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-646-4466
Provider Business Practice Location Address Fax Number:
615-673-1273
Provider Enumeration Date:
08/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3320 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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