Healthcare Provider Details

I. General information

NPI: 1689161663
Provider Name (Legal Business Name): MORGAN BUDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W WALNUT ST
JOHNSON CITY TN
37604-6527
US

IV. Provider business mailing address

917 W WALNUT ST
JOHNSON CITY TN
37604-6527
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-6464
  • Fax: 423-439-7118
Mailing address:
  • Phone: 423-439-6464
  • Fax: 423-439-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72222
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: