Provider Demographics
NPI:1992160212
Name:MODERN AIDS INC
Entity type:Organization
Organization Name:MODERN AIDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ACA, BC-HIS
Authorized Official - Phone:865-577-3500
Mailing Address - Street 1:216 PHOENIX CT
Mailing Address - Street 2:STE C
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865
Mailing Address - Country:US
Mailing Address - Phone:865-577-3500
Mailing Address - Fax:865-577-3311
Practice Address - Street 1:216 PHOENIX CT
Practice Address - Street 2:STE C
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3914
Practice Address - Country:US
Practice Address - Phone:865-577-3500
Practice Address - Fax:865-577-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN660237700000X
TN789237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty