Registry details
Type
Individual
Primary specialty
Hospitalist
Enumerated
Jan 4, 2007
License(s)
42193 (TN), 42193 (TN), 42193 (TN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 401 TAKOMA AVE | Greeneville, TN 37743-4647 | 423-278-1743 |
| MAILING | PO BOX 1869 ATTN: DANIELLE BOLICK, PROVIDER ENROLLMENT | Fletcher, NC 28732-1869 | 828-687-5616 |
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