Provider Demographics
NPI:1275393522
Name:WELLMONT MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WELLMONT MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-6565
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6567
Mailing Address - Fax:
Practice Address - Street 1:701 MED TECH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2371
Practice Address - Country:US
Practice Address - Phone:423-302-3480
Practice Address - Fax:423-833-0599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLMONT MEDICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty