Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

East Tennessee State University

Organization Family Medicine Physician · NPI 1285264531

East Tennessee State University is a Family Medicine Physician in Johnson City, Tennessee. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

1081 John Robert Bell Dr Rm W-127
Johnson City, TN 37614
Phone: (972) 367-4845
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1285264531
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Administrator/Agent · (972) 367-4845
Other names Etsu Sports Medicine; Etsu Sports Medicine
NPI enumeratedJanuary 24, 2020
Last updated in NPPESDecember 17, 2021
Certification dateDecember 17, 2021
Mailing address15305 Dallas Pkwy Ste 800, Addison, TX 75001-6415

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