DR. RAY WALLACE METTETAL JR. (NPI# 1730387036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730387036 |
| Entity Type | Individual |
| Full Name | DR. RAY WALLACE METTETAL JR. |
| Credential | M.D. |
| Practice Address |
303 E 11th Ave Johnson City TN 37601-3932 |
| Practice Telephone | 4233417538 |
| Mailing Telephone | 4233417538 |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD 10753 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | BC BS | 086382 | 01 |
| Street Address |
303 E 11TH AVE |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37601-3932 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396381992 | Juan Carlos Simon Villegas Gomez | Specialist/Technologist | 1081 John Robert Bell Dr, Johnson City, TN 37601 | 2019-11-19 |
| 1629537279 | Jaima Suzanne Price | Hearing Instrument Specialist | 106 E Watauga Avenue, Johnson City, TN 37601 | 2019-03-13 |
| 1275004467 | Brittany Howell | Speech-Language Pathologist | 2114 E. Fairview Ave, Johnson City, TN 37601 | 2018-12-16 |
| 1194229948 | Heather Chantel Lester | Physical Therapist | 2114 E. Fairview Avenue, Johnson City, TN 37601 | 2018-03-19 |
| 1477061869 | Patrick Conway Reynolds | Specialist/Technologist | 1081 John Robert Bell Drive, Johnson City, TN 37601 | 2018-01-19 |
| 1790201135 | Surgical Services of East Tennessee PC | Surgery | 300 East Main St., Suite 301, Johnson City, TN 37601 | 2017-08-17 |
| 1073065694 | Davina Leah Reppond | Home Health | 1204 E Myrtle Ave, Johnsoncity, TN 37601 | 2016-10-31 |
| 1003365503 | Wendi Y Minutolo | Behavioral Analyst | 403 Princeton Rd Ste 3, Johnson City, TN 37601 | 2016-09-25 |
| 1306208798 | Rachel Anne Anderson | Nurse Practitioner | 1118 East Holston Avenue, Johnson City, TN 37601 | 2016-03-24 |
| 1932560976 | Kaydee Louise Davidson | Occupational Therapist | 3209 Bristol Highway, Johnson City, TN 37601 | 2016-03-18 |
| Find all providers in zip 37601 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194958215 | Tanzila Shams Kulman | Psychiatry & Neurology | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604 | 2009-08-24 |
| 1942310149 | Pamela J. Costello, Md, PC | Psychiatry & Neurology | 3915 Bristol Hwy Ste 103, Johnson City, TN 37601-1400 | 2006-08-30 |
| 1457365876 | Pamela J Costello | Psychiatry & Neurology | 3915 Bristol Hwy Ste 301, Johnson City, TN 37601-1403 | 2006-07-28 |
| 1992750673 | Yi Annette Huang | Psychiatry & Neurology | 105 Woodlawn Drive, Johnson City, TN 37604-5978 | 2006-05-23 |
| 1245213545 | Nathaniel Robb Whaley | Psychiatry & Neurology | 1321 Sunset Drive, Suite 11, Johnson City, TN 37604-7902 | 2005-11-22 |
| 1205830536 | Fernando Bendfeldt | Psychiatry & Neurology | 101 Med Tech Pkwy, Ste 407, Johnson City, TN 37604-4000 | 2005-05-23 |
| 1922574474 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604-6972 | 2018-10-22 |
| 1265987325 | Upstate University Clinical Campus Medical Group At Binghamton, Inc. | Psychiatry & Neurology | 46 Harrison St, Johnson City, NY 13790-2120 | 2016-08-18 |
| 1659776375 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604-6971 | 2014-10-23 |
| 1548503642 | Derek Y Yuan | Psychiatry & Neurology | 52 Harrison St Fl 2, Johnson City, NY 13790-2120 | 2013-03-27 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.