Healthcare Provider Details

I. General information

NPI: 1982745741
Provider Name (Legal Business Name): PULMONARY ASSOCIATES OF KINGSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W MAIN ST SUITE 3
LEBANON VA
24266-4214
US

IV. Provider business mailing address

111 W STONE DR SUITE 100
KINGSPORT TN
37660-6027
US

V. Phone/Fax

Practice location:
  • Phone: 276-415-9160
  • Fax: 276-415-9162
Mailing address:
  • Phone: 423-247-5197
  • Fax: 423-247-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY HAWKINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-247-5197