Organization
SOUTHSIDE SENIOR CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL E COX OD (OWNER)
(423) 929-2020
Entity
Organization
Contact information
Practice address
2306 KNOB CREEK RD, JOHNSON CITY, TN 37604-2366
(423) 943-3079
Mailing address
2306 KNOB CREEK RD, JOHNSON CITY, TN 37604-2366
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1349
NC
Other
Enumeration date
04/02/2008
Last updated
11/05/2012
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