Healthcare Provider Details

I. General information

NPI: 1932165040
Provider Name (Legal Business Name): MICHAEL H ANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 W OAKLAND AVE SUITE 1
JOHNSON CITY TN
37604-2357
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 423-915-5000
  • Fax: 423-915-5045
Mailing address:
  • Phone: 423-302-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD38979
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: