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General NPI Number Information
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NPI Number | 1356234272
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Entity Type | Organization
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Legal Business Name | URBAN RADIANCE MEDICAL SPA
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 5675 W ANDREW JOHNSON HWY
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City | MORRISTOWN
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State | TN
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Zip | 37814-1031
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Country | US
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Telephone | 423-839-0710
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Fax | 689-232-4757
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Provider Business Mailing Address
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Address Line | 5675 W ANDREW JOHNSON HWY
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City | MORRISTOWN
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State | TN
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Zip | 37814-1031
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Country | US
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Telephone | 423-839-0710
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Fax | 689-232-4757
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | HEATHER A MULLINS
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Credential |
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Telephone | 423-839-0710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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