Healthcare Provider Details

I. General information

NPI: 1740622281
Provider Name (Legal Business Name): ALESHA CARROLL MCCONNELL-CARMONY P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HOLT CT
GREENEVILLE TN
37743-6917
US

IV. Provider business mailing address

2717 E OAKLAND AVE
JOHNSON CITY TN
37601-1843
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-0213
  • Fax:
Mailing address:
  • Phone: 423-926-2358
  • Fax: 423-926-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2276
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: