Healthcare Provider Details

I. General information

NPI: 1093322141
Provider Name (Legal Business Name): ABBAS AGHA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2292 CHAMBLISS AVE NW STE F
CLEVELAND TN
37311-3862
US

IV. Provider business mailing address

2292 CHAMBLISS AVE NW STE F
CLEVELAND TN
37311-3862
US

V. Phone/Fax

Practice location:
  • Phone: 423-641-4261
  • Fax: 877-370-2529
Mailing address:
  • Phone: 423-641-4261
  • Fax: 877-370-2529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SYED A. ABBAS
Title or Position: OWNER
Credential: MD
Phone: 603-667-8912