Organization
SMOKIE MOUNTAIN DIALYSIS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY EUGENE VERMILLION M.D. (PRESIDENT)
(423) 232-8882
Entity
Organization
Contact information
Practice address
101 MED TECH PKWY, SUITE 406, JOHNSON CITY, TN 37604-4007
(423) 232-8882
Mailing address
PO BOX 4087, JOHNSON CITY, TN 37602-4087
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4146761
—
TN
Enumeration date
10/24/2006
Last updated
04/04/2011
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