Organization
MEDICAL EDUCATION ASSISTANCE CORPORATION
Active
Other names
Innovation Lab Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL E LEWIS (EXECUTIVE DIRECTOR)
(423) 433-6050
Entity
Organization
Contact information
Practice address
2109 W MARKET ST STE 140, JOHNSON CITY, TN 37604
(423) 433-6050
(423) 433-6060
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 433-6050
(423) 433-6060
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/23/2013
Last updated
08/22/2018
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