# RAY W. METTETAL JR., M.D. INC.

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

## Provider details

- **NPI number:** 1043451578
- **Authorized official:** DR. RAY WALLACE METTETAL JR. M.D. (PRESIDENT/OWNER)
- **Authorized official phone:** (423) 341-7538

## Contact information

- **Practice address:** 329 WESLEY ST STE 4, JOHNSON CITY, TN 37601-1721
- **Practice address phone:** (423) 282-5411
- **Practice address fax:** (423) 282-5951
- **Mailing address:** 303 E 11TH AVE, JOHNSON CITY, TN 37601-3932
- **Mailing address phone:** (423) 282-5411
- **Mailing address fax:** (423) 282-5951

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD 10753 | TN | Yes |

## Other

- **Enumeration date:** 03/12/2009
- **Last updated:** 03/12/2009