Healthcare Provider Details

I. General information

NPI: 1114136546
Provider Name (Legal Business Name): JOSEPH E. BIEBERLY, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BROWNS MILL RD PMB 386 SUITE 6
JOHNSON CITY TN
37604-4100
US

IV. Provider business mailing address

630 ONEEGA LN SUITE A
ERWIN TN
37650-2197
US

V. Phone/Fax

Practice location:
  • Phone: 423-854-0001
  • Fax: 423-854-0002
Mailing address:
  • Phone: 423-854-0001
  • Fax: 423-854-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD12505
License Number StateTN

VIII. Authorized Official

Name: JOSEPH E BIEBERLY
Title or Position: OWNER
Credential: MD
Phone: 423-854-0001