Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | CPT 07 | TN |
NPI | 1245398650 |
---|---|
Provider Name | Dr. Tommy D. Knowles-Bagwell |
First Address | Nashville, TN 37204-3232 |
Second Address | Nashville, TN 37204-3232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 09/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4110514 | BLUE CROSS ANDBLUE SHIELD (01) | TN |