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410 N State Of Franklin Rd Suite 135 Johnson City TN 37604-6971 | |
| (423) 431-2350 | |
| (423) 431-2372 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 410 N State Of Franklin Rd, Johnson City, Tennessee |
| Authorized Official Name and Position | Carl Steven Kilgore (PRESIDENT / CEO) |
| Authorized Official Contact | 4233023051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
410 N State Of Franklin Rd Suite 135 Johnson City TN 37604-6971 Ph: (423) 431-2350 | 410 N State Of Franklin Rd Suite 135 Johnson City TN 37604-6971 Ph: (423) 431-2350 |
| NPI Number | 1659776375 |
|---|---|
| Provider Enumeration Date | 10/23/2014 |
| Last Update Date | 03/29/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659776375 | NPI | - | NPPES |
| Q010028 | Medicaid | TN | |
| 1659776375 | Medicaid | VA | |
| CA5744 | Other | TN | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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