Healthcare Provider Details

I. General information

NPI: 1487616942
Provider Name (Legal Business Name): ATTENTUS OF SCOTT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

IV. Provider business mailing address

PO BOX 4609
ONEIDA TN
37841-4609
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-2121
  • Fax: 423-569-8640
Mailing address:
  • Phone: 423-569-7918
  • Fax: 423-569-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY M. CROSS
Title or Position: BOM
Credential:
Phone: 423-569-8521