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General NPI Number Information
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NPI Number | 1952367187
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES OF MCMINN COUNTY PC
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 301 GRADY ROAD
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City | ETOWAH
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State | TN
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Zip | 37331-0325
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Country | US
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Telephone | 423-263-2444
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Fax | 423-263-1553
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | ETOWAH
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State | TN
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Zip | 37331-0325
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Country | US
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Telephone | 423-263-2444
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Fax | 423-263-1553
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Authorized Official
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Title or Position | CEO
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Name | DR. RUSSELL BRANDON WATTERS III
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Credential | MD
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Telephone | 423-263-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 025977
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 029515
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 023767
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 025977
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39591
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 39591
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 023529
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License Number State | TN
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