Provider Demographics
NPI:1184644932
Name:UROLOGY ASSOCIATES OF KINGSPORT, P. C.
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF KINGSPORT, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:423-246-6251
Mailing Address - Street 1:822 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3718
Mailing Address - Country:US
Mailing Address - Phone:423-246-6251
Mailing Address - Fax:423-246-7230
Practice Address - Street 1:822 BROAD ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3718
Practice Address - Country:US
Practice Address - Phone:423-246-6251
Practice Address - Fax:423-246-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371556Medicare ID - Type UnspecifiedGROUP ID #