Provider Demographics
NPI:1083735484
Name:KINGSPORT UROLOGY GROUP
Entity Type:Organization
Organization Name:KINGSPORT UROLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WOODROW
Authorized Official - Middle Name:W
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-4155
Mailing Address - Street 1:1932 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4602
Mailing Address - Country:US
Mailing Address - Phone:423-349-6679
Mailing Address - Fax:423-246-7169
Practice Address - Street 1:1932 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4602
Practice Address - Country:US
Practice Address - Phone:423-349-6679
Practice Address - Fax:423-246-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty