Provider Demographics
NPI:1770790065
Name:DAYSPRING HEALTH INC
Entity type:Organization
Organization Name:DAYSPRING HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:423-784-8492
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:P.O. BOX 540
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2154
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762
Practice Address - Country:US
Practice Address - Phone:423-784-8492
Practice Address - Fax:423-784-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty