MEDICARE: JONESBOROUGH MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M30739	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376074385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONESBOROUGH MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1003 E JACKSON BLVD STE 3
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1531
Country	:	US
Telephone Number	:	423-753-6077
Fax Number	:	423-753-8788

Provider Business Practice Location Address
First Line	:	2811 W MARKET ST STE 1
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5127
Country	:	US
Telephone Number	:	423-928-2135
Fax Number	:	423-928-5814

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ATIF ATYIA
Credential	:	MD
Telephone Number	:	423-753-6077

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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