Basic Information
| Provider Information | |||||||||
| NPI: | 1124077292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMSEY | ||||||||
| FirstName: | GLYNDA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 SUNSET DR | ||||||||
| Address2: | STE 3 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376047906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239264966 | ||||||||
| FaxNumber: | 4239261823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 SUNSET DR | ||||||||
| Address2: | STE 3 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376047906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239264966 | ||||||||
| FaxNumber: | 4239261823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 19631 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3042966 | 01 | TN | BCBS | OTHER | 7217251 | 01 | VA | VIRGINIA MEDICAID | OTHER | 3047174 | 05 | TN | MEDICAID | 64925647 | 01 | KY | KENTUCKY MEDICAID | OTHER | 7905194 | 01 | NC | NORTH CAROLINA MEDICAID | OTHER |