Healthcare Provider Details

I. General information

NPI: 1780953729
Provider Name (Legal Business Name): MEDICAL EDUCATION ASSISTANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 SUNSET DR SUITE 103
JOHNSON CITY TN
37604-3799
US

IV. Provider business mailing address

PO BOX 2204
JOHNSON CITY TN
37605-2204
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-7246
  • Fax: 423-282-4698
Mailing address:
  • Phone: 423-433-6050
  • Fax: 423-433-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD35556
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD35556
License Number StateTN

VIII. Authorized Official

Name: RUSSELL E LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 423-433-6050