Healthcare Provider Details

I. General information

NPI: 1497719322
Provider Name (Legal Business Name): BRITTANY M CANTRELL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W OAKLAND AVE SUITE 301
JOHNSON CITY TN
37604-2191
US

IV. Provider business mailing address

1021 W OAKLAND AVE SUITE 301
JOHNSON CITY TN
37604-2191
US

V. Phone/Fax

Practice location:
  • Phone: 423-952-8000
  • Fax: 423-952-8001
Mailing address:
  • Phone: 423-952-8000
  • Fax: 423-952-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00911
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: