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General NPI Number Information
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NPI Number | 1164258968
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Entity Type | Organization
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Legal Business Name | GREENE COUNTY EMPLOYEE CLINIC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 401 TAKOMA AVE STE 207
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City | GREENEVILLE
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State | TN
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Zip | 37743-4647
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Country | US
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Telephone | 423-798-2053
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Fax | 423-798-2054
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Provider Business Mailing Address
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Address Line | 401 TAKOMA AVE STE 207
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City | GREENEVILLE
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State | TN
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Zip | 37743-4647
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Country | US
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Telephone | 423-798-2053
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Fax | 423-798-2054
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | LESLIE JONES
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Credential | RN
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Telephone | 423-798-2053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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