Healthcare Provider Details

I. General information

NPI: 1346248556
Provider Name (Legal Business Name): GARY ANTHONY MILITANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SEWELL DR
SPARTA TN
38583-1223
US

IV. Provider business mailing address

1320 OLD WEISGARBER RD
KNOXVILLE TN
37909-1291
US

V. Phone/Fax

Practice location:
  • Phone: 931-738-4173
  • Fax:
Mailing address:
  • Phone: 865-694-6919
  • Fax: 865-694-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15329
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: