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NPI Code Detail

MEDICARE: JONI GLAVAN SAGO M.D.

MEDICARE: JONI GLAVAN SAGO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianMD0000037765TN

General Provider Information

NPI Number : 1932187200
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONI GLAVAN SAGO M.D.
Provider Business Mailing Address
First Line : 1627 OLD GRAY STATION RD STE 30
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37615-4194
Country : US
Telephone Number : 423-782-6645
Fax Number :
Provider Business Practice Location Address
First Line : 2300 W STONE DR
Second Line :
City : KINGSPORT
State : TN
Zip : 37660-2360
Country : US
Telephone Number : 423-246-4961
Fax Number : 423-245-3136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 12/29/2025

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