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General NPI Number Information
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NPI Number | 1679021422
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Entity Type | Individual
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Provider Name | JOANIE WILSON RDH
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Gender | Female
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 208 PARKWAY BLVD
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2845
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Country | US
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Telephone | 423-543-5200
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Fax | 423-543-1499
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Provider Business Mailing Address
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Address Line | 103 STARLIGHT DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-6145
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Country | US
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Telephone | 423-213-7789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5089
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License Number State | TN
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