Healthcare Provider Details

I. General information

NPI: 1205814605
Provider Name (Legal Business Name): ERNESTO MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MCFARLAND ST SUITE B
MORRISTOWN TN
37814
US

IV. Provider business mailing address

500 MCFARLAND ST SUITE B
MORRISTOWN TN
37814
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-0740
  • Fax: 423-581-0063
Mailing address:
  • Phone: 423-587-0740
  • Fax: 423-581-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25075
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: