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General NPI Number Information
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NPI Number | 1235254525
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Entity Type | Organization
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Legal Business Name | SYCAMORE SHOALS ANESTHESIA ASSOCIATES PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 922 WEST G STREET
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2935
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Country | US
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Telephone | 423-542-2738
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Fax | 423-542-2738
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | ELIZABETHTON
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State | TN
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Zip | 37644-0040
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Country | US
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Telephone | 423-542-2738
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Fax | 423-542-2738
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Authorized Official
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Title or Position | OFFICE MANAGER BD SECY
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Name | MRS. NYOKA JEAN HOLDER
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Credential |
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Telephone | 423-542-2738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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