Provider Demographics
NPI:1528091386
Name:JOHNSON CITY OB/GYN ASSOCIATES
Entity type:Organization
Organization Name:JOHNSON CITY OB/GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-979-2536
Mailing Address - Street 1:2 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6583
Mailing Address - Country:US
Mailing Address - Phone:423-926-8813
Mailing Address - Fax:423-926-8910
Practice Address - Street 1:2 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 21
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6583
Practice Address - Country:US
Practice Address - Phone:423-926-8813
Practice Address - Fax:423-926-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3718898Medicaid
NC790241QMedicaid
TN4068254OtherBCBS OF TENNESSEE
=========OtherJOHN DEERE INSURANCE CO
=========OtherJOHN DEERE INSURANCE CO