# EAST TENNESSEE MEDICAL GROUP, P.C.

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

## Provider details

- **NPI number:** 1053895268
- **Authorized official:** KHAIRIYA C BRYANT ESQ (CREDENTIALING MANAGER)
- **Authorized official phone:** (864) 343-0010

## Contact information

- **Practice address:** 281 UNDERPASS DR, ONEIDA, TN 37841-5885
- **Practice address phone:** (423) 569-5454
- **Practice address fax:** (423) 569-5858
- **Mailing address:** 25 AIRPARK CT, GREENVILLE, SC 29607-6188
- **Mailing address phone:** (864) 343-0010
- **Mailing address fax:** (864) 312-6927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/24/2018
- **Last updated:** 09/24/2018