Provider Demographics
NPI:1023209780
Name:ASBURY INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:ASBURY INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:VASTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-525-7220
Mailing Address - Street 1:2725 ASBURY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-6441
Mailing Address - Country:US
Mailing Address - Phone:865-525-7220
Mailing Address - Fax:865-525-7407
Practice Address - Street 1:2725 ASBURY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-6441
Practice Address - Country:US
Practice Address - Phone:865-525-7220
Practice Address - Fax:865-525-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI32760Medicare UPIN