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General NPI Number Information
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NPI Number | 1285916791
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Entity Type | Organization
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Legal Business Name | NORTHEAST TENNESSEE EMERGENCY PHYSICIANS PC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 127 HEALTH CARE DR
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-2853
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Country | US
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Telephone | 276-546-7440
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Fax | 386-274-7891
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Provider Business Mailing Address
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Address Line | PO BOX 11827
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City | DAYTONA BEACH
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State | FL
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Zip | 32120-1827
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Country | US
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Telephone | 888-311-8760
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Fax | 386-274-7891
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN MARK WOODARD
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Credential | MD
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Telephone | 423-946-9791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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