| Ima Etowah | |
|
301 Grady Rd Etowah TN 37331-1924 | |
| (423) 263-1743 | |
| (423) 263-7723 |
| Full Name | Ima Etowah |
|---|---|
| Speciality | Internal Medicine |
| Location | 301 Grady Rd, Etowah, Tennessee |
| Authorized Official Name and Position | Zandra M Mills (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8655002144 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ima Etowah 1275 Dick Lonas Rd Unit 101 Knoxville TN 37909-1383 Ph: (865) 500-2144 | Ima Etowah 301 Grady Rd Etowah TN 37331-1924 Ph: (423) 263-1743 |
| NPI Number | 1891418232 |
|---|---|
| Provider Enumeration Date | 09/21/2022 |
| Last Update Date | 09/21/2022 |
| Certification Date | 09/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891418232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
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