Provider Demographics
NPI:1972149169
Name:TENNET LLC
Entity type:Organization
Organization Name:TENNET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPRAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-705-4543
Mailing Address - Street 1:1618 MARS HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4847
Mailing Address - Country:US
Mailing Address - Phone:706-705-4543
Mailing Address - Fax:
Practice Address - Street 1:1618 MARS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4847
Practice Address - Country:US
Practice Address - Phone:706-705-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447275805OtherNPI