Provider Demographics
NPI:1205898673
Name:EAST TENNESSEE INTERNAL MEDICINE ASSOCIATES PC C/O BROOKS MORELOCK
Entity type:Organization
Organization Name:EAST TENNESSEE INTERNAL MEDICINE ASSOCIATES PC C/O BROOKS MORELOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:GARTH
Authorized Official - Last Name:MORELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-787-1024
Mailing Address - Street 1:1406 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4332
Mailing Address - Country:US
Mailing Address - Phone:423-787-1024
Mailing Address - Fax:423-787-1050
Practice Address - Street 1:1406 TUSCULUM BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4332
Practice Address - Country:US
Practice Address - Phone:423-787-1024
Practice Address - Fax:423-787-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5408651OtherCIGNA
TN3384756Medicaid
TNTN0101OtherJOHN DEERE
TN4047882OtherBLUE CROSS/BLUE SHIELD
TNH09874Medicare UPIN
TN3878172Medicare ID - Type UnspecifiedMEDICARE