Healthcare Provider Details

I. General information

NPI: 1982927778
Provider Name (Legal Business Name): ANESTHESIA OF NORTHEAST TENNESSEE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N STATE OF FRANKLIN RD STE 202
JOHNSON CITY TN
37604-6008
US

IV. Provider business mailing address

PO BOX 4860
MURRELLS INLET SC
29576-2698
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-8973
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL T MITCHELL
Title or Position: BUS MANAGER
Credential:
Phone: 843-651-2624