Individual
TARA VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
325 N STATE OF FRANKLIN RD FL 1, JOHNSON CITY, TN 37604-6056
(423) 439-7272
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
200101293
NC
207V00000X
Obstetrics & Gynecology Physician
Primary
62336
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q065587
—
TN
Enumeration date
07/12/2006
Last updated
01/29/2024
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