Organization
EAST TENNESSEE UROLOGIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAY D JONES (OFFICE MANAGER)
(423) 928-0168
Entity
Organization
Contact information
Practice address
508 PRINCETON RD, SUITE 104, JOHNSON CITY, TN 37601-2060
(423) 928-0168
(423) 928-5141
Mailing address
508 PRINCETON RD, SUITE 104, JOHNSON CITY, TN 37601-2060
(423) 928-0168
(423) 928-5141
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3382693
—
TN
01
—
CF2875
RAILROAD MEDICARE
TN
Enumeration date
05/10/2006
Last updated
08/22/2020
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