Healthcare Provider Details

I. General information

NPI: 1407303571
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF EAST TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 JESSAMINE ST
KNOXVILLE TN
37917-7726
US

IV. Provider business mailing address

616 JESSAMINE ST
KNOXVILLE TN
37917-7726
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-9622
  • Fax: 865-521-7418
Mailing address:
  • Phone: 865-525-9622
  • Fax: 865-521-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM DICKSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 865-368-9623