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General NPI Number Information
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NPI Number | 1508879719
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE VASCULAR CENTER, PLLC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 1125 W 1ST NORTH ST STE. B
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City | MORRISTOWN
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State | TN
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Zip | 37814-4562
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Country | US
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Telephone | 423-317-6560
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Fax | 423-317-6570
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Provider Business Mailing Address
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Address Line | PO BOX 1855
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City | MORRISTOWN
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State | TN
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Zip | 37816-1855
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Country | US
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Telephone | 423-317-6560
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Fax | 423-317-6570
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MR. SHAHIN ASSADNIA
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Credential | M.D.
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Telephone | 423-317-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD35881
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License Number State | TN
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