MEDICARE: DR. JOEL A DANISI 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
1	207R00000X	Internal Medicine Physician	61448	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972529683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL A DANISI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 699
Second Line	:
City	:	MOUNTAIN HOME
State	:	TN
Zip	:	37684-0699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SHERIDAN SQ STE 200
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-7435
Country	:	US
Telephone Number	:	423-246-7931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/17/2024

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