Healthcare Provider Details

I. General information

NPI: 1811325624
Provider Name (Legal Business Name): MICHAEL DUNN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 GALLAHER RD
KINGSTON TN
37763-4215
US

IV. Provider business mailing address

629 GALLAHER RD
KINGSTON TN
37763-4215
US

V. Phone/Fax

Practice location:
  • Phone: 865-376-3416
  • Fax: 865-376-3532
Mailing address:
  • Phone: 865-376-3416
  • Fax: 865-376-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6640
License Number StateTN

VIII. Authorized Official

Name: MR. MICHAEL L. MCELHINNEY
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 865-376-3416