Healthcare Provider Details

I. General information

NPI: 1770790065
Provider Name (Legal Business Name): DAYSPRING HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S MAIN ST
JELLICO TN
37762
US

IV. Provider business mailing address

107 S MAIN ST P.O. BOX 540
JELLICO TN
37762-2154
US

V. Phone/Fax

Practice location:
  • Phone: 423-784-8492
  • Fax: 423-784-8358
Mailing address:
  • Phone: 423-784-8492
  • Fax: 423-784-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: W MARK WATT
Title or Position: CEO
Credential: CEO
Phone: 423-784-8492