Basic Information
| Provider Information | |||||||||
| NPI: | 1811382393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSHING | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | CALLON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 MED TECH PKWY STE 1 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239292111 | ||||||||
| FaxNumber: | 4239290497 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 MED TECH PKWY | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347644190 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2015 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4301117032 | MI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 61002 | TN | N | 207W00000X | 61002 | TN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.