Healthcare Provider Details

I. General information

NPI: 1952213431
Provider Name (Legal Business Name): PRINCE FLOYD RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MAIN AVE
ERWIN TN
37650-1435
US

IV. Provider business mailing address

703 N MAIN AVE
ERWIN TN
37650-1435
US

V. Phone/Fax

Practice location:
  • Phone: 828-380-9870
  • Fax:
Mailing address:
  • Phone: 828-380-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number0120014788
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCRT93688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: