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Phillip Tidwell
NPI 1659680114 · on the registry since 2010 · sole proprietor
Practice
- Address
- 2148 Aztec Dr
Dyersburg, TN 38024 - Phone
- (731) 589-6156
- Fax
- (615) 467-8971
- Organisation at this address
- Proactive Md, Llc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 2279P1004X
2279P1004X
- Licence states on file
- TN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2013-06-12
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee