Healthcare Provider Details

I. General information

NPI: 1912418435
Provider Name (Legal Business Name): SUNRISE MEDICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WORTH CIR STE 100
JOHNSON CITY TN
37601-4358
US

IV. Provider business mailing address

9 WORTH CIR STE 100
JOHNSON CITY TN
37601-4358
US

V. Phone/Fax

Practice location:
  • Phone: 423-641-1033
  • Fax: 866-560-9772
Mailing address:
  • Phone: 423-641-1033
  • Fax: 866-560-9772

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: HAYLEY GREGG
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 423-641-1033