Organization
EASTLAKE MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA MICHELLE MADRON (PRACTICE ADMIN)
(423) 352-6500
Entity
Organization
Contact information
Practice address
2205 JACKSBORO PIKE, LA FOLLETTE, TN 37766-2904
(423) 352-6500
(423) 352-6501
Mailing address
2205 JACKSBORO PIKE, LA FOLLETTE, TN 37766-2904
(423) 352-6500
(423) 352-6501
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
11/04/2024
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