Organization
SURGICAL GROUP OF NORTHEAST TENNESSEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD JOHNSON FORE M.D. (MEDICAL DOCTOR)
(423) 743-4151
Entity
Organization
Contact information
Practice address
361 OKOLONA DR, ERWIN, TN 37650-2183
(423) 743-4151
(423) 743-7580
Mailing address
361 OKOLONA DR, ERWIN, TN 37650-2183
(423) 743-4151
(423) 743-7580
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD0000026800
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3700364
—
TN
Enumeration date
08/31/2006
Last updated
08/22/2020
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