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General NPI Number Information
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NPI Number | 1750485322
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC ASSOCIATES OF KINGSPORT LLP
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 444 CLINCHFIELD ST STE 101
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City | KINGSPORT
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State | TN
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Zip | 37660-3859
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Country | US
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Telephone | 423-392-6500
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Fax | 423-392-6504
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Provider Business Mailing Address
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Address Line | 444 CLINCHFIELD ST STE 101
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City | KINGSPORT
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State | TN
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Zip | 37660-3859
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Country | US
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Telephone | 423-392-6500
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Fax | 423-392-6504
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Authorized Official
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Title or Position | M.D. PARTNER
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Name | DR. ERIC D MOFFET
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Credential | M.D.
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Telephone | 423-392-6500
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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 | MD0000016494
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD0000013797
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD0000020620
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License Number State | TN
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