Individual
MISS MARY L MICHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
302 WESLEY ST, STE 10, JOHNSON CITY, TN 37601-1740
(423) 928-9007
(423) 928-9249
Mailing address
1810 FAIRWAY DR, JOHNSON CITY, TN 37601-2206
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD0000003984
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3846544
—
TN
05
—
6738371
—
VA
05
—
6906086
—
NC
Enumeration date
08/04/2005
Last updated
03/12/2008
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