Provider Demographics
NPI:1609299130
Name:HIGHLANDS UROLOGY
Entity Type:Organization
Organization Name:HIGHLANDS UROLOGY
Other - Org Name:HIGHLANDS VASECTOMY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-571-5487
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-0547
Mailing Address - Country:US
Mailing Address - Phone:423-571-5487
Mailing Address - Fax:423-573-8102
Practice Address - Street 1:28 MIDWAY ST
Practice Address - Street 2:LL SUITE 1
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1706
Practice Address - Country:US
Practice Address - Phone:423-571-5487
Practice Address - Fax:423-573-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF82324Medicare UPIN