Provider Demographics
NPI:1760739197
Name:STAIR, ARTHUR WINFIELD (SPC)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:WINFIELD
Last Name:STAIR
Suffix:
Gender:M
Credentials:SPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N BOONE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5693
Mailing Address - Country:US
Mailing Address - Phone:423-928-8001
Mailing Address - Fax:423-928-8007
Practice Address - Street 1:207 N BOONE ST STE 1200
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-928-8001
Practice Address - Fax:423-928-8007
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist