Healthcare Provider Details

I. General information

NPI: 1487737367
Provider Name (Legal Business Name): NEONATOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W PARK DR SUITE 9B
KINGSPORT TN
37660-3824
US

IV. Provider business mailing address

146 W PARK DR SUITE 9B
KINGSPORT TN
37660-3824
US

V. Phone/Fax

Practice location:
  • Phone: 423-246-3220
  • Fax: 423-246-3221
Mailing address:
  • Phone: 423-246-3220
  • Fax: 423-246-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON ELAINE LAIL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-246-3220