=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043531932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL GASS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2010
-----------------------------------------------------
Last Update Date | 08/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1503 W ELK AVE STE 5
-----------------------------------------------------
City | ELIZABETHTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37643-2883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-542-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1503 W ELK AVE STE 5
-----------------------------------------------------
City | ELIZABETHTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37643-2883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-542-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 60809
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------