# JOHNSON CITY UROLOGICAL CLINIC, P.C.

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

## Provider details

- **NPI number:** 1578689253
- **Authorized official:** GRANT D TAYLOR M.D. (OWNER)
- **Authorized official phone:** (423) 926-6112

## Contact information

- **Practice address:** 2340 KNOB CREEK ROAD, SUITE 720, JOHNSON CITY, TN 37604-2977
- **Practice address phone:** (423) 926-6112
- **Practice address fax:** (423) 434-0278
- **Mailing address:** 2340 KNOB CREEK ROAD, SUITE 720, JOHNSON CITY, TN 37604-2977
- **Mailing address phone:** (423) 926-6112
- **Mailing address fax:** (423) 434-0278

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2088P0231X | Pediatric Urology Physician | — | NULL | Yes |
| 2088P0231X | Pediatric Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2007
- **Last updated:** 08/19/2009