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General NPI Number Information
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NPI Number | 1215056171
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Entity Type | Organization
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Legal Business Name | SPECIALTY MEDICAL SERVICES, INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 188 16TH AVE STE 104
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City | DAYTON
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State | TN
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Zip | 37321-1038
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Country | US
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Telephone | 423-570-0097
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Fax | 423-570-0808
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Provider Business Mailing Address
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Address Line | 188 16TH AVE STE 104
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City | DAYTON
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State | TN
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Zip | 37321-1038
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Country | US
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Telephone | 423-570-0097
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Fax | 423-570-0808
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EDWARD D JOHNSON
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Credential | MD
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Telephone | 423-570-0097
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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 | MD13288
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License Number State | TN
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