Healthcare Provider Details

I. General information

NPI: 1508334129
Provider Name (Legal Business Name): ADO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 N BROAD ST
TAZEWELL TN
37879-4323
US

IV. Provider business mailing address

951 N BROAD ST
TAZEWELL TN
37879-4323
US

V. Phone/Fax

Practice location:
  • Phone: 423-259-8661
  • Fax: 423-259-8662
Mailing address:
  • Phone: 423-259-8661
  • Fax: 423-259-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LEWIS MARTIN
Title or Position: CEO
Credential:
Phone: 423-259-8661