Healthcare Provider Details

I. General information

NPI: 1104812734
Provider Name (Legal Business Name): CELSO T EBEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N STATE OF FRANKLIN RD STE 303
JOHNSON CITY TN
37604-6051
US

IV. Provider business mailing address

PO BOX 632476
CINCINNATI OH
45263-2476
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-8181
  • Fax: 423-926-4421
Mailing address:
  • Phone: 423-926-8181
  • Fax: 423-926-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number41941
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number41941
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number41941
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: