Healthcare Provider Details

I. General information

NPI: 1508879719
Provider Name (Legal Business Name): EAST TENNESSEE VASCULAR CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W 1ST NORTH ST STE. B
MORRISTOWN TN
37814-4562
US

IV. Provider business mailing address

PO BOX 1855
MORRISTOWN TN
37816-1855
US

V. Phone/Fax

Practice location:
  • Phone: 423-317-6560
  • Fax: 423-317-6570
Mailing address:
  • Phone: 423-317-6560
  • Fax: 423-317-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD35881
License Number StateTN

VIII. Authorized Official

Name: MR. SHAHIN ASSADNIA
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 423-317-6560