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525 N State Of Franklin Rd Johnson City TN 37604-8213 | |
| (423) 302-4380 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 525 N State Of Franklin Rd, Johnson City, Tennessee |
| Authorized Official Name and Position | Carl Steven Kilgore (PRESIDENT) |
| Authorized Official Contact | 4233023051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
509 Med Tech Pkwy Ste 100 Johnson City TN 37604-2579 Ph: (423) 302-6567 | 525 N State Of Franklin Rd Johnson City TN 37604-8213 Ph: (423) 302-4380 |
| NPI Number | 1154779817 |
|---|---|
| Provider Enumeration Date | 06/02/2016 |
| Last Update Date | 09/27/2022 |
| Certification Date | 09/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154779817 | NPI | - | NPPES |
| 1154779817 | Medicaid | VA | |
| Q022855 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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