Healthcare Provider Details

I. General information

NPI: 1629002043
Provider Name (Legal Business Name): MARC D COUNTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 MEADOWVIEW PKWY
KINGSPORT TN
37660-7475
US

IV. Provider business mailing address

2050 MEADOWVIEW PKWY
KINGSPORT TN
37660-7475
US

V. Phone/Fax

Practice location:
  • Phone: 423-230-5000
  • Fax: 423-390-6852
Mailing address:
  • Phone: 423-230-5000
  • Fax: 423-390-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101235404
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number31853
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: