Provider Demographics
NPI:1912578824
Name:CHRISTIAN TERZIAN, MD, PLLC
Entity Type:Organization
Organization Name:CHRISTIAN TERZIAN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-566-8283
Mailing Address - Street 1:2435 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2910
Mailing Address - Country:US
Mailing Address - Phone:423-566-2250
Mailing Address - Fax:423-563-5873
Practice Address - Street 1:919 E CENTRAL AVE STE 101B
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2778
Practice Address - Country:US
Practice Address - Phone:423-566-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505396Medicaid