Provider Demographics
NPI:1790192565
Name:PAUL-ENNIS, YONETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:YONETTE
Middle Name:
Last Name:PAUL-ENNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YONETTE
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:2202 N JOHN B DENNIS HWY STE 100
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5904
Practice Address - Country:US
Practice Address - Phone:423-578-8500
Practice Address - Fax:423-578-8569
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60487207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology