Healthcare Provider Details

I. General information

NPI: 1417360751
Provider Name (Legal Business Name): E.E. MEDICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LONG RD
KINGSTON TN
37763-5316
US

IV. Provider business mailing address

150 LONG RD
KINGSTON TN
37763-5316
US

V. Phone/Fax

Practice location:
  • Phone: 865-399-2681
  • Fax:
Mailing address:
  • Phone: 865-399-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39250
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number39250
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1137
License Number StateTN

VIII. Authorized Official

Name: PATRECIA E EATON
Title or Position: MANAGING MEMBER
Credential: P.A.
Phone: 865-399-2681