Organization
JOHNSON CITY UROLOGICAL CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT D TAYLOR M.D. (OWNER)
(423) 926-6112
Entity
Organization
Contact information
Practice address
2340 KNOB CREEK ROAD, SUITE 720, JOHNSON CITY, TN 37604-2977
(423) 926-6112
(423) 434-0278
Mailing address
2340 KNOB CREEK ROAD, SUITE 720, JOHNSON CITY, TN 37604-2977
(423) 926-6112
(423) 434-0278
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3172410
—
TN
Enumeration date
03/22/2007
Last updated
08/19/2009
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