Healthcare Provider Details

I. General information

NPI: 1578529632
Provider Name (Legal Business Name): GASTROINTESTINAL ASSOCIATES OF NORTHEAST TENNESSEE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N STATE OF FRANKLIN RD SUITE 202
JOHNSON CITY TN
37604-6008
US

IV. Provider business mailing address

310 N STATE OF FRANKLIN RD SUITE 202
JOHNSON CITY TN
37604-6008
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-7111
  • Fax: 423-929-9448
Mailing address:
  • Phone: 423-929-7111
  • Fax: 423-929-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: MS. PENNY B RUTLEDGE
Title or Position: ADMINISTRATOR
Credential: FACMPE, MPH
Phone: 423-929-7111