Provider Demographics
NPI:1376074385
Name:JONESBOROUGH MEDICAL CENTER
Entity Type:Organization
Organization Name:JONESBOROUGH MEDICAL CENTER
Other - Org Name:DOCTOR'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ATYIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-753-6077
Mailing Address - Street 1:1003 E JACKSON BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1531
Mailing Address - Country:US
Mailing Address - Phone:423-753-6077
Mailing Address - Fax:423-753-8788
Practice Address - Street 1:2811 W MARKET ST STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5127
Practice Address - Country:US
Practice Address - Phone:423-928-2135
Practice Address - Fax:423-928-5814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONESBOROUGH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNM30739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3874725Medicaid
TN3874725Medicare PIN
TNH48896Medicare UPIN