Healthcare Provider Details

I. General information

NPI: 1174727309
Provider Name (Legal Business Name): NEUROBEHAVIORAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WORTH CIR STE 2
JOHNSON CITY TN
37601-4306
US

IV. Provider business mailing address

2 WORTH CIR STE 2
JOHNSON CITY TN
37601-4306
US

V. Phone/Fax

Practice location:
  • Phone: 423-952-0992
  • Fax: 423-952-0284
Mailing address:
  • Phone: 423-952-0992
  • Fax: 423-952-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number103GC0700X
License Number StateTN

VIII. Authorized Official

Name: DR. RODNEY A SULLIVAN
Title or Position: OWNER
Credential: PH.D.
Phone: 423-952-0992