Organization
KINGSTON FAMILY PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWIGHT H WILLETT M.D. (PRESIDENT)
(865) 376-3406
Entity
Organization
Contact information
Practice address
820 W RACE ST, KINGSTON, TN 37763-2120
(865) 376-3406
(865) 376-9091
Mailing address
820 W RACE ST, KINGSTON, TN 37763-2120
(865) 376-3406
(865) 376-9091
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080080789
RAILROAD MEDICARE
TN
01
—
080153049
RAILROAD MEDICARE
TN
01
—
443961
RIVERBEND MEDICARE
TN
Enumeration date
09/27/2006
Last updated
05/10/2023
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