Organization
INTERNAL MEDICINE ASSOCIATES OF MCMINN COUNTY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL BRANDON WATTERS III MD (CEO)
(423) 263-2444
Entity
Organization
Contact information
Practice address
301 GRADY ROAD, ETOWAH, TN 37331-0325
(423) 263-2444
(423) 263-1553
Mailing address
PO BOX 325, ETOWAH, TN 37331-0325
(423) 263-2444
(423) 263-1553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
023529
TN
207R00000X
Internal Medicine Physician
023767
TN
207R00000X
Internal Medicine Physician
025977
TN
207R00000X
Internal Medicine Physician
029515
TN
207R00000X
Internal Medicine Physician
39591
TN
207RN0300X
Nephrology Physician
025977
TN
207RS0010X
Sports Medicine (Internal Medicine) Physician
39591
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE0552
MEDICARE RR
TN
Enumeration date
04/25/2006
Last updated
12/14/2009
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