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General NPI Number Information
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NPI Number | 1710936257
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE UROLOGIC ASSOCIATES
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 508 PRINCETON RD SUITE 104
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2060
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Country | US
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Telephone | 423-928-0168
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Fax | 423-928-5141
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Provider Business Mailing Address
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Address Line | 508 PRINCETON RD SUITE 104
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2060
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Country | US
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Telephone | 423-928-0168
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Fax | 423-928-5141
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KAY D JONES
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Credential |
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Telephone | 423-928-0168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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