Provider Demographics
NPI:1447397666
Name:STATE OF TENNESSEE
Entity Type:Organization
Organization Name:STATE OF TENNESSEE
Other - Org Name:WASHINGTON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY DIRECTOR 3
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSEH
Authorized Official - Phone:423-975-7927
Mailing Address - Street 1:219 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2062
Mailing Address - Country:US
Mailing Address - Phone:423-975-2200
Mailing Address - Fax:423-975-2210
Practice Address - Street 1:219 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2062
Practice Address - Country:US
Practice Address - Phone:423-979-4609
Practice Address - Fax:423-979-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN444-7994Medicaid
TN3910500Medicare ID - Type Unspecified