=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184610248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHSTAR PHYSICIANS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 W MORRIS BLVD STE. 400A
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-581-5925
-----------------------------------------------------
Fax | 423-581-2828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 W MORRIS BLVD STE 400A
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-2262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-581-5925
-----------------------------------------------------
Fax | 423-581-2828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | ODESSA BRABSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-581-5925
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD 17188
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------