MEDICARE: NICHOLAS ALEXANDER TSAMBASSIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy	MD-019687	TN
2	207R00000X	Internal Medicine Physician	MD-019687	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103I118390	OTHER	TN	PTAN LOCAL PART B

General Provider Information

NPI Number	:	1174628523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ALEXANDER TSAMBASSIS M.D.

Provider Business Mailing Address
First Line	:	127 DEAN DRIVE
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-3981
Country	:	US
Telephone Number	:	931-906-9473
Fax Number	:	931-906-9477

Provider Business Practice Location Address
First Line	:	127 DEAN DRIVE
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-3981
Country	:	US
Telephone Number	:	931-906-9473
Fax Number	:	931-906-9477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/22/2018

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