# EAST TENNESSEE PEDIATRICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023542784
- **Authorized official:** GREGORY B CAIN (PRESIDENT)
- **Authorized official phone:** (423) 442-2121

## Contact information

- **Practice address:** 3959 HIGHWAY 411, MADISONVILLE, TN 37354-4417
- **Practice address phone:** (423) 442-2121
- **Mailing address:** 3959 HIGHWAY 411, MADISONVILLE, TN 37354-4417

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 04/19/2017
- **Last updated:** 06/09/2017