Basic Information
| Provider Information | |||||||||
| NPI: | 1780789115 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATHWAYS OF TENNESSEE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 238 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315418200 | ||||||||
| FaxNumber: | 7315418327 | ||||||||
| Practice Location | |||||||||
| Address1: | 238 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319358200 | ||||||||
| FaxNumber: | 7319358327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 7315415000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | L-216-016-6123 | TN | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | L-216-016-6123 | 01 | TN | DEPT OF MHDD LICENSE NUMB | OTHER | 249 | 01 | TN | DOH LICENSE NUMBER | OTHER |