Provider Demographics
NPI:1114023447
Name:KAMMONA, HUSSEIN ALWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:ALWAN
Last Name:KAMMONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 PERSIMMON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-7126
Mailing Address - Country:US
Mailing Address - Phone:865-320-6008
Mailing Address - Fax:
Practice Address - Street 1:1924 ALCOA HIGHWAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9000
Practice Address - Fax:865-539-8008
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30198207P00000X
TN30198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64043169Medicaid
TN3825792Medicaid
TN930096029OtherRAILROAD MEDICARE
TN3095965OtherBCBS OF TENNESSEE
TN3095965OtherBCBS OF TENNESSEE
KY64043169Medicaid