Healthcare Provider Details

I. General information

NPI: 1053451690
Provider Name (Legal Business Name): CARTER COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E G ST
ELIZABETHTON TN
37643-3223
US

IV. Provider business mailing address

110 MOUNTAIN VIEW CIR
JOHNSON CITY TN
37601-5256
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-2521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number0125502
License Number StateTN

VIII. Authorized Official

Name: BRANDY DAVIS
Title or Position: RN
Credential:
Phone: 423-543-2521