Provider Demographics
NPI:1144491416
Name:APPALACHIAN CENTER FOR WOMEN, PC
Entity type:Organization
Organization Name:APPALACHIAN CENTER FOR WOMEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-982-0886
Mailing Address - Street 1:417 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5816
Mailing Address - Country:US
Mailing Address - Phone:865-982-0886
Mailing Address - Fax:865-982-0841
Practice Address - Street 1:417 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5816
Practice Address - Country:US
Practice Address - Phone:865-982-0886
Practice Address - Fax:865-982-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702738Medicare PIN