Provider Demographics
NPI:1174628523
Name:TSAMBASSIS, NICHOLAS ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:TSAMBASSIS
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 1:127 DEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3981
Mailing Address - Country:US
Mailing Address - Phone:931-906-9473
Mailing Address - Fax:931-906-9477
Practice Address - Street 1:127 DEAN DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3981
Practice Address - Country:US
Practice Address - Phone:931-906-9473
Practice Address - Fax:931-906-9477
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD-0196873336C0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I118390OtherPTAN LOCAL PART B