Provider Demographics
NPI:1376513721
Name:COMBS, LANDON S (MD)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:S
Last Name:COMBS
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 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:115 JUDGE GRESHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6213
Practice Address - Country:US
Practice Address - Phone:423-477-2885
Practice Address - Fax:423-477-0113
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN295182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3836479Medicaid
TN3836479Medicaid
TNP00460047Medicare PIN
TN103I372931Medicare PIN
TN3836479Medicare PIN
G51737Medicare UPIN