Healthcare Provider Details

I. General information

NPI: 1730245010
Provider Name (Legal Business Name): FRONTIER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 EDDIE WILLIAMS RD
JOHNSON CITY TN
37601-2872
US

IV. Provider business mailing address

PO BOX 9054
GRAY TN
37615-9054
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-5627
  • Fax: 423-928-4222
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberL 229-076-1429
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CRISTI L BLALOCK
Title or Position: DIR. CONTRACTING/COMPLIANCE
Credential: MBA
Phone: 423-467-3741