Healthcare Provider Details

I. General information

NPI: 1639178932
Provider Name (Legal Business Name): SHAHIN ASSADNIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
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

1125 W 1ST NORTH ST STE. B
MORRISTOWN TN
37814-4562
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:
Title or Position:
Credential:
Phone: