Provider Demographics
NPI:1689134231
Name:DRAGONFLY MEDICAL AND BEHAVIORAL HEALTH PROFESSSIONAL CORPORATION
Entity Type:Organization
Organization Name:DRAGONFLY MEDICAL AND BEHAVIORAL HEALTH PROFESSSIONAL CORPORATION
Other - Org Name:DRAGONFLY MEDICAL AND BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-588-9978
Mailing Address - Street 1:216 QUAIL RUN CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5364
Mailing Address - Country:US
Mailing Address - Phone:423-525-7488
Mailing Address - Fax:
Practice Address - Street 1:102 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3525
Practice Address - Country:US
Practice Address - Phone:423-588-9978
Practice Address - Fax:423-722-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty