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General NPI Number Information
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NPI Number | 1346248556
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Entity Type | Individual
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Provider Name | GARY ANTHONY MILITANA MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 401 SEWELL DR
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City | SPARTA
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State | TN
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Zip | 38583-1223
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Country | US
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Telephone | 931-738-4173
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 OLD WEISGARBER RD
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City | KNOXVILLE
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State | TN
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Zip | 37909-1291
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Country | US
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Telephone | 865-694-6919
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Fax | 865-694-4339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 15329
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License Number State | TN
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