Healthcare Provider Details

I. General information

NPI: 1023077534
Provider Name (Legal Business Name): RATHEANY SAKBUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557B DANNAHER DR SUITE G55
POWELL TN
37849-3568
US

IV. Provider business mailing address

7557B DANNAHER DR SUITE G55
POWELL TN
37849-3568
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-7370
  • Fax: 865-859-7389
Mailing address:
  • Phone: 865-859-7370
  • Fax: 865-859-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD52312
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: