Healthcare Provider Details

I. General information

NPI: 1689134231
Provider Name (Legal Business Name): DRAGONFLY MEDICAL AND BEHAVIORAL HEALTH PROFESSSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N BROADWAY ST
JOHNSON CITY TN
37601-3525
US

IV. Provider business mailing address

216 QUAIL RUN CT
JOHNSON CITY TN
37601-5364
US

V. Phone/Fax

Practice location:
  • Phone: 423-588-9978
  • Fax: 423-722-3401
Mailing address:
  • Phone: 423-525-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW JOHN CAFFREY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 423-588-9978