Individual
HENRY RENICK HARTSOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1901 S SHADY ST, MOUNTAIN CITY, TN 37683-2021
(423) 727-1100
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5715
TN
207Q00000X
Family Medicine Physician
NA
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113764317
DRIVER LICENSE NUMBER
TN
Enumeration date
04/06/2021
Last updated
08/16/2024
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