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General NPI Number Information
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NPI Number | 1679040075
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Entity Type | Organization
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Legal Business Name | CRESTPOINT PSYCHIATRIC CARE, LLC
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 206 PRINCETON RD STE 18
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2025
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Country | US
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Telephone | 423-631-0024
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Fax | 423-631-0047
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Provider Business Mailing Address
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Address Line | PO BOX 4358
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City | JOHNSON CITY
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State | TN
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Zip | 37602-4358
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Country | US
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Telephone | 423-913-4188
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | FAITH AIMUA
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Credential | M.D
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Telephone | 423-631-0024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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