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2109 W Market St Ste 140 Johnson City TN 37604 | |
| (423) 433-6050 | |
| (423) 433-6060 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2109 W Market St Ste 140, Johnson City, Tennessee |
| Authorized Official Name and Position | Russell E Lewis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4234336050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 699 Mountain Home TN 37684-0699 Ph: (423) 433-6050 | 2109 W Market St Ste 140 Johnson City TN 37604 Ph: (423) 433-6050 |
| NPI Number | 1194146894 |
|---|---|
| Provider Enumeration Date | 12/23/2013 |
| Last Update Date | 08/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194146894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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