Provider Demographics
NPI:1306875224
Name:UNICOI MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:UNICOI MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-743-6141
Mailing Address - Street 1:105 GAY STREET
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650
Mailing Address - Country:US
Mailing Address - Phone:423-743-6141
Mailing Address - Fax:423-743-1083
Practice Address - Street 1:105 GAY ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1227
Practice Address - Country:US
Practice Address - Phone:423-743-6141
Practice Address - Fax:423-743-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMC8808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380594Medicaid
TNB02772Medicare UPIN
TN3380594Medicaid