Healthcare Provider Details

I. General information

NPI: 1588677678
Provider Name (Legal Business Name): ATIF A ATYIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E JACKSON BLVD
JONESBOROUGH TN
37659-1538
US

IV. Provider business mailing address

1003 E JACKSON BLVD
JONESBOROUGH TN
37659-1538
US

V. Phone/Fax

Practice location:
  • Phone: 423-753-6077
  • Fax: 423-753-8788
Mailing address:
  • Phone: 423-753-6077
  • Fax: 423-753-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD30739
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD30739
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD30739
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30739
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: