Provider Demographics
NPI:1083715338
Name:ASSOCIATED NEUROLOGISTS OF KINGSPORT
Entity Type:Organization
Organization Name:ASSOCIATED NEUROLOGISTS OF KINGSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-247-5553
Mailing Address - Street 1:8 SHERIDAN SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7479
Mailing Address - Country:US
Mailing Address - Phone:423-247-5553
Mailing Address - Fax:423-247-9254
Practice Address - Street 1:8 SHERIDAN SQ STE 200
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7479
Practice Address - Country:US
Practice Address - Phone:423-247-5553
Practice Address - Fax:423-247-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3701692Medicaid
TN3701692Medicaid