Healthcare Provider Details

I. General information

NPI: 1003935321
Provider Name (Legal Business Name): MCC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/16/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E WATAUGA AVE
JOHNSON CITY TN
37601-4038
US

IV. Provider business mailing address

501 E WATAUGA AVE
JOHNSON CITY TN
37601-4038
US

V. Phone/Fax

Practice location:
  • Phone: 423-722-8446
  • Fax: 423-722-5674
Mailing address:
  • Phone: 423-722-8446
  • Fax: 423-722-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN POWELL
Title or Position: FACILITY DIRECTOR
Credential: MSN, FNP-BC
Phone: 423-722-8446