Healthcare Provider Details

I. General information

NPI: 1609031608
Provider Name (Legal Business Name): YASMIN M ELSHENAWY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SUSANNAH ST STE A
JOHNSON CITY TN
37601
US

IV. Provider business mailing address

2400 SUSANNAH ST STE A
JOHNSON CITY TN
37601-1730
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-4734
  • Fax: 423-283-4736
Mailing address:
  • Phone: 423-283-4734
  • Fax: 423-283-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD000049476
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: