Healthcare Provider Details

I. General information

NPI: 1750905642
Provider Name (Legal Business Name): SAI KARTHIK KOMMINENI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date: 01/18/2022
Reactivation Date: 07/25/2022

III. Provider practice location address

2428 KNOB CREEK RD STE 201
JOHNSON CITY TN
37604-2396
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-5054
  • Fax: 423-390-6850
Mailing address:
  • Phone: 423-952-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75663
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: