Healthcare Provider Details

I. General information

NPI: 1588641138
Provider Name (Legal Business Name): MARC A. VALLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 W OAKLAND AVE 222
JOHNSON CITY TN
37604-1445
US

IV. Provider business mailing address

928 W. OAKLAND SUITE 222
JOHNSON CITY TN
37604
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-3379
  • Fax:
Mailing address:
  • Phone: 423-282-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number38667
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: