Prince, Tidence Lane

Prince, Tidence Lane is an individual health care provider with primary practice located at 611 Morganton Square Dr , Maryville TN 37801-4763. He recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy & Immunology, which is considered as his primary health care specialty. Prince, Tidence Lane can be contacted via phone (865) 584-8588.

Contact Information

Primary practice address
611 Morganton Square Dr Maryville TN 37801-4763
Phone: (865) 584-8588
Fax: (865) 584-3364
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X 21247 Tennessee

Profile Details

NPI number 1215922356
LBN Legal business name Prince, Tidence Lane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2005
Last updated Feb 8th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215922356 NPPES
Tennessee MEDICAID 3068515

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