Provider Demographics
NPI:1386123222
Name:NOTLOB ENTERPRISES
Entity type:Organization
Organization Name:NOTLOB ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, APRN, FNP-C
Authorized Official - Phone:931-432-5849
Mailing Address - Street 1:3624 LONG LANE RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-8012
Mailing Address - Country:US
Mailing Address - Phone:214-876-1248
Mailing Address - Fax:931-432-4481
Practice Address - Street 1:260 W 5TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1754
Practice Address - Country:US
Practice Address - Phone:931-432-5849
Practice Address - Fax:931-400-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-11
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care