Organization
MMDS OF KINGSPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LLOYD M. WILLIAMS JR. (OWNER)
(423) 230-8093
Entity
Organization
Contact information
Practice address
1038 S WILCOX DR, SUITE 115, KINGSPORT, TN 37660-5378
(423) 230-8093
(423) 230-4932
Mailing address
1038 S WILCOX DR, SUITE 115, KINGSPORT, TN 37660-5378
(423) 230-8093
(423) 230-4932
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00237335
MEDICARE RAIL ROAD
—
Enumeration date
10/13/2005
Last updated
10/15/2008
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