1194182246 NPI number — MRS. NICHOLE GRICE LAMBERTH MPT

Table of content: MRS. NICHOLE GRICE LAMBERTH MPT (NPI 1194182246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194182246 NPI number — MRS. NICHOLE GRICE LAMBERTH MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMBERTH
Provider First Name:
NICHOLE
Provider Middle Name:
GRICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194182246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 LIMEKILN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENNESSEE RIDGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37178-5521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-721-3402
Provider Business Mailing Address Fax Number:
931-721-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3507 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37061-4148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-289-5460
Provider Business Practice Location Address Fax Number:
931-289-5461
Provider Enumeration Date:
01/20/2016

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: 2251X0800X , with the licence number:  6675 , 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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