Provider Demographics
NPI:1902311723
Name:EMMANUEL HEALTH SERVICES
Entity Type:Organization
Organization Name:EMMANUEL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SEANDRIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-380-1978
Mailing Address - Street 1:2049 AMBERGATE LN APT 5
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4456
Mailing Address - Country:US
Mailing Address - Phone:662-380-1978
Mailing Address - Fax:
Practice Address - Street 1:2049 AMBERGATE LN APT 5
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4456
Practice Address - Country:US
Practice Address - Phone:662-380-1978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty