Healthcare Provider Details

I. General information

NPI: 1891110433
Provider Name (Legal Business Name): JOHN D. SANABRIA, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MEDICAL PARK DR SUITE 103
LENOIR CITY TN
37772-5782
US

IV. Provider business mailing address

460 MEDICAL PARK DR SUITE 103
LENOIR CITY TN
37772-5782
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-0038
  • Fax: 865-271-0040
Mailing address:
  • Phone: 865-271-0038
  • Fax: 865-271-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28120
License Number StateTN

VIII. Authorized Official

Name: DR. JOHN D. SANABRIA
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 865-271-0038