Provider Demographics
NPI:1699290130
Name:EDENS, BURENA JERVENE (ATC)
Entity type:Individual
Prefix:
First Name:BURENA
Middle Name:JERVENE
Last Name:EDENS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:MILLIGAN COLLEGE
Mailing Address - State:TN
Mailing Address - Zip Code:37682-0500
Mailing Address - Country:US
Mailing Address - Phone:423-461-8991
Mailing Address - Fax:423-461-8738
Practice Address - Street 1:PO BOX 500
Practice Address - Street 2:
Practice Address - City:MILLIGAN COLLEGE
Practice Address - State:TN
Practice Address - Zip Code:37682-0500
Practice Address - Country:US
Practice Address - Phone:423-461-8991
Practice Address - Fax:423-461-8738
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1300207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine