Provider Demographics
NPI:1639403645
Name:GARDNER, STEVEN G (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4877
Mailing Address - Country:US
Mailing Address - Phone:423-929-2584
Mailing Address - Fax:423-722-2060
Practice Address - Street 1:341 WALLACE RD STE A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8001
Practice Address - Country:US
Practice Address - Phone:615-834-3123
Practice Address - Fax:615-834-3008
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003139363A00000X
TN1879363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant