Healthcare Provider Details

I. General information

NPI: 1942294863
Provider Name (Legal Business Name): DONALD GABRIEL POLK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: D. GABRIEL POLK D.O.

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 JV MANGUBAT DR
WAYNESBORO TN
38485-2440
US

IV. Provider business mailing address

2717 EAST OAKLAND AVENUE
JOHNSON CITY TN
37601-1843
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9418
  • Fax: 931-722-9081
Mailing address:
  • Phone: 423-926-2358
  • Fax: 423-926-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: