Provider Demographics
NPI:1164258968
Name:GREENE COUNTY EMPLOYEE CLINIC
Entity type:Organization
Organization Name:GREENE COUNTY EMPLOYEE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-798-2053
Mailing Address - Street 1:401 TAKOMA AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4647
Mailing Address - Country:US
Mailing Address - Phone:423-798-2053
Mailing Address - Fax:423-798-2054
Practice Address - Street 1:401 TAKOMA AVE STE 207
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4647
Practice Address - Country:US
Practice Address - Phone:423-798-2053
Practice Address - Fax:423-798-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty